Pediatr Gastroenterol Hepatol Nutr.  2015 Mar;18(1):60-65. 10.5223/pghn.2015.18.1.60.

Disseminated Cytomegalovirus Infection and Protein Losing Enteropathy as Presenting Feature of Pediatric Patient with Crohn's Disease

• Cakir M
• Ersoz S
• Akbulut UE

• KMID: 2315537
• DOI: http://doi.org/10.5223/pghn.2015.18.1.60

Abstract

We report a pediatric patient admitted with abdominal pain, diffuse lower extremity edema and watery diarrhea for two months. Laboratory findings including complete blood count, serum albumin, lipid and immunoglobulin levels were compatible with protein losing enteropathy. Colonoscopic examination revealed diffuse ulcers with smooth raised edge (like "punched out holes") in the colon and terminal ileum. Histopathological examination showed active colitis, ulcerations and inclusion bodies. Immunostaining for cytomegalovirus was positive. Despite supportive management, antiviral therapy, the clinical condition of the patient worsened and developed disseminated cytomegalovirus infection and the patient died. Protein losing enteropathy and disseminated cytomegalovirus infection a presenting of feature in steroid-naive patient with inflammatory bowel disease is very rare. Hypogammaglobulinemia associated with protein losing enteropathy in Crohn's disease may predispose the cytomegalovirus infection in previously healthy children.

Keyword

Crohn disease; Cytomegalovirus infections; Protein-losing enteropathies

MeSH Terms

Abdominal Pain
Agammaglobulinemia
Blood Cell Count
Child
Colitis
Colon
Crohn Disease*
Cytomegalovirus
Cytomegalovirus Infections*
Diarrhea
Edema
Humans
Ileum
Immunoglobulins
Inclusion Bodies
Inflammatory Bowel Diseases
Lower Extremity
Protein-Losing Enteropathies*
Serum Albumin
Ulcer
Immunoglobulins
Serum Albumin

Figure

• 

  Fig. 1 (A) Colonoscopic finding of the patient on admission. Note the ulcer with smooth raised edge (like "punched out holes"). (B) Aphthous ulcers in the cecum suggesting Crohn's disease.

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  Fig. 2 (A) Cyrptitis and active chronic inflammation in the lamina propria of the colonic mucosa suggesting active colitis (H&E, ×200). (B) Immunostaining for cytomegalovirus (CMV) antigen, brownish appearance in the vascular endothelial cells indicates CMV-positive cells (immunohistochemistry, ×400).

• 

  Fig. 3 Treatment regimen of the patient. IV, intra-venous.

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