Decoding norovirus infection in Crohn's disease.

Although a causing viral infectious agent remains untraceable in Crohn's disease, most recent genome-wide association studies have linked the FUT2 W143X mutation (resulting in asymptomatic norovirus infection) with the pathogenesis of Crohn's ileitis and with vitamin B12 deficiency (i.e., a known risk factor for Crohn's disease with ileal involvement). In line with these findings, host variations in additional genes involved in host response to norovirus infection (such as ATG16L1 and NOD2) predispose humans to Crohn's ileitis. One may therefore presume that asymptomatic norovirus infection may contribute to disruption of the stability of the gut microbiota leading to Crohn's ileitis. These paradigms highlight not only the need to revisit the potential transmissibility of Crohn's disease, but also potential safety issues of forthcoming clinical trials on human probiotic infusions in Crohn's ileitis by rigorous donors screening program.

Cytomegalovirus enteritis mimicking Crohn's disease in a lupus nephritis patient: a case report.

Cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract has been reported in both immunocompetent and, more frequently, in immunocompromised patients. We describe a case of a 19-year-old male who developed CMV infection of the terminal ileum while receiving immunosuppression for lupus nephritis. This was a distinctly unusual site of infection which clinically mimicked Crohn's ileitis. We note that reports of terminal ileal CMV infection have been infrequent. Despite a complicated hospital course, ganciclovir therapy was effective in resolving his symptoms and normalizing his ileal mucosa. This report highlights the importance of accurate histological diagnosis and clinical follow-up of lupus patients with GI symptoms undergoing intense immunosuppression.

Cytomegalovirus ileitis associated with goblet cell carcinoid tumour of the appendix.

We report a female patient with cytomegalovirus (CMV) terminal ileitis and CMV viraemia, associated with a metastatic goblet cell carcinoid (GCC) tumour of the appendix. She was treated with ileocaecal resection followed by ganciclovir. We highlight the importance of vigilant histopathological assessment and discuss the existing literature on gastrointestinal CMV infection in immunocompetent patients.

Cytomegalovirus ileitis in an immunocompetent elderly adult.

Cytomegalovirus enteritis is most usually associated with patients positive for human immunodeficiency virus or immunosuppressed transplant patients. The gastrointestinal tract may be affected anywhere from the esophagus to the colon, but the small bowel involvement is rare. We report a case of cytomegalovirus ileitis in an immunocompetent adult, which was confirmed by histopathologic findings through colonoscopic biopsy.

Necrotizing ileitis caused by cytomegalovirus in patient with systemic lupus erythematosus: case report.

We report a systemic lupus erythematosus (SLE) patient with necrotizing ileitis diagnosed at a tertially care centre in Thailand. The patient was surgically explored because peritonitis was suspected and segmental gangrenous and perforation of the terminal iliem were found. The pathological finding was necrotizing ileitis with appearance of cytomegalic intranuclear inclusion body. The presence of cytomegalovirus (CMV) infection in tissue was confirmed by CMV-DNA detection using polymerase chain reaction and ELISA probe hybridization method. The hemoculture and peritoneal fluid culture results revealed no pathogenic organisms. Postoperatively, the clinical course of the patient deteriorated and she developed hypotension. Vasopressive drugs were administered without clinical improvement. She expired on day 5 postoperation. Regarding CMV infection, the organism involves the small bowel in only 4.3 per cent of all CMV infections of the gastrointestinal tract. Isolated cases of ileal perforation due to CMV infection have never been reported in a SLE patient. Thus, chronic right lower abdominal pain, fever with or without diarrhea in immunocompromised patients should cause clinicians to consider CMV ileitis in the differential diagnosis. Immediate surgical resection and prompt antiviral therapy lead to successful treatment.

Cytomegalovirus enteritis causing massive bleeding in a patient with AIDS.

An emergency operation was performed on a 58 year-old heterosexual male patient for massive lower gastrointestinal bleeding, which was caused by cytomegalovirus (CMV) related ulceration at the terminal ileum. Pre-operative endoscopic evaluation revealed multiple esophageal and gastric ulcerations in upper gastrointestinal tract and much fresh blood in distal colon. Angiography showed vascular tufts and extravasation of contrast medium in the cecal area. Angiodysplasia of cecum with massive bleeding was initially impressed. However, CMV enteritis was identified in the resected ileum, the diagnosis of Acquired Immunodeficiency Syndrome (AIDS) was confirmed by subsequent serological tests. AIDS was unknown to treating physicians until diagnosed by pathological specimen. Massive lower gastrointestinal bleeding related to CMV ulceration in small bowel is rare, we report this unusual presentation and highlight the the suspicion of immunocompromised state of patients with unusual, multiple gastro-intestinal ulcers.