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PICTURES IN CLINICAL MEDICINE
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Cytomegalovirus Colitis in a Lung Cancer Patient Nobuaki Ochi 1, Hirofumi Kawamoto 2, Yasumasa Monobe 3 and Nagio Takigawa 1 Key words: lung cancer, cytomegalovirus colitis, chemotherapy, radiotherapy
(Intern Med 55: 2313-2314, 2016) (DOI: 10.2169/internalmedicine.55.6534)
Picture.
A 76-year-old man with advanced lung adenocarcinoma was treated with S-1 and carboplatin as a first-line treatment. After the first cycle of chemotherapy, he suffered from metastatic pelvic bone pain and therefore received palliative radiotherapy. Subsequently, he experienced chronic refractory diarrhea up to ten times a day. Repeated fecal cultures and Clostridium difficile toxin tests were both negative. Colon fiberscopy revealed diffuse deep ulcers in the rectum (Picture A, B), which were compatible with findings of cytomegalovirus (CMV) colitis (1). CMV antigen-positive blood leucocytes (antigenemia) were detected. A CMV infection was thus confirmed immunohistochemically by the identification of nuclear and cytoplasmic inclusions using
anti-CMV antibody in rectal tissue biopsy specimens (Picture C, D). After he was intravenously treated with ganciclovir for 20 days, his intractable diarrhea substantially improved. It is therefore important to be aware of the possibility that CMV colitis can cause refractory diarrhea, although standard chemotherapy and radiotherapy for solid cancers rarely induces this disease (1, 2). The authors state that they have no Conflict of Interest (COI).
References
１
1. Teraishi F, Shimamura H, Suzuki T, et al. Cytomegalovirus colitis
Department of General Internal Medicine 4, Kawasaki Hospital, Kawasaki Medical School, Japan, ２ Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Japan and ３ Department of Pathology, Kawasaki Hospital, Kawasaki Medical School, Japan Received for publication September 8, 2015; Accepted for publication November 10, 2015 Correspondence to Dr. Nagio Takigawa, [email protected]
2313
Intern Med 55: 2313-2314, 2016
DOI: 10.2169/internalmedicine.55.6534
after systemic chemotherapy in a patient with recurrent colon cancer: a case report. J Med Case Rep 2: 289, 2008. 2. Griffiths PD. Burden of disease associated with human cytomega-
lovirus and prospects for elimination by universal immunisation. Lancet Infect Dis 12: 790-798, 2012.
Ⓒ 2016 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
2314
PICTURES IN CLINICAL MEDICINE
□
Cytomegalovirus Colitis in a Lung Cancer Patient Nobuaki Ochi 1, Hirofumi Kawamoto 2, Yasumasa Monobe 3 and Nagio Takigawa 1 Key words: lung cancer, cytomegalovirus colitis, chemotherapy, radiotherapy
(Intern Med 55: 2313-2314, 2016) (DOI: 10.2169/internalmedicine.55.6534)
Picture.
A 76-year-old man with advanced lung adenocarcinoma was treated with S-1 and carboplatin as a first-line treatment. After the first cycle of chemotherapy, he suffered from metastatic pelvic bone pain and therefore received palliative radiotherapy. Subsequently, he experienced chronic refractory diarrhea up to ten times a day. Repeated fecal cultures and Clostridium difficile toxin tests were both negative. Colon fiberscopy revealed diffuse deep ulcers in the rectum (Picture A, B), which were compatible with findings of cytomegalovirus (CMV) colitis (1). CMV antigen-positive blood leucocytes (antigenemia) were detected. A CMV infection was thus confirmed immunohistochemically by the identification of nuclear and cytoplasmic inclusions using
anti-CMV antibody in rectal tissue biopsy specimens (Picture C, D). After he was intravenously treated with ganciclovir for 20 days, his intractable diarrhea substantially improved. It is therefore important to be aware of the possibility that CMV colitis can cause refractory diarrhea, although standard chemotherapy and radiotherapy for solid cancers rarely induces this disease (1, 2). The authors state that they have no Conflict of Interest (COI).
References
１
1. Teraishi F, Shimamura H, Suzuki T, et al. Cytomegalovirus colitis
Department of General Internal Medicine 4, Kawasaki Hospital, Kawasaki Medical School, Japan, ２ Department of General Internal Medicine 2, Kawasaki Hospital, Kawasaki Medical School, Japan and ３ Department of Pathology, Kawasaki Hospital, Kawasaki Medical School, Japan Received for publication September 8, 2015; Accepted for publication November 10, 2015 Correspondence to Dr. Nagio Takigawa, [email protected]
2313
Intern Med 55: 2313-2314, 2016
DOI: 10.2169/internalmedicine.55.6534
after systemic chemotherapy in a patient with recurrent colon cancer: a case report. J Med Case Rep 2: 289, 2008. 2. Griffiths PD. Burden of disease associated with human cytomega-
lovirus and prospects for elimination by universal immunisation. Lancet Infect Dis 12: 790-798, 2012.
Ⓒ 2016 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
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