PMID- 34260544
OWN - NLM
STAT- MEDLINE
DCOM- 20210729
LR  - 20230103
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 100
IP  - 28
DP  - 2021 Jul 16
TI  - Multiple small bowel perforations due to cytomegalovirus related immune 
      reconstitution inflammatory syndrome in an HIV patient: A case report.
PG  - e26605
LID - 10.1097/MD.0000000000026605 [doi]
LID - e26605
AB  - RATIONALE: The presentation of multiple intestinal perforations is a severe 
      complication of enteric cytomegalovirus (CMV) infection, sometimes associated 
      with immune reconstitution inflammatory syndrome (IRIS) after the initiation of 
      antiretroviral therapy (ART) in patients with human immunodeficiency virus (HIV). 
      Here we reported a rare case of a patient with HIV infection who developed 
      multiple perforations in the small bowel shortly after ART initiation without any 
      prodromal gastrointestinal symptoms. We also reviewed the literature of reported 
      cases to clarify their clinical characteristics for early diagnosis and rapid 
      intervention. PATIENT CONCERNS: A patient with HIV presented with fever after 
      16 days of ART initiation and was admitted to our hospital. He was treated with 
      intravenous ganciclovir due to persistent CMV viremia. The fever resolved 10 days 
      later. However, he reported persistent left lower abdominal pain. DIAGNOSES: The 
      patient was diagnosed with multiple small bowel perforations, CMV-related IRIS, 
      and acquired immune deficiency syndrome. An upright abdominal x-ray in a tertiary 
      level hospital revealed bilateral moderate intraperitoneal free air. We performed 
      a pathological examination and metagenomic next-generation sequencing. CMV 
      enteritis was confirmed by immunohistochemical staining and other opportunistic 
      infections were excluded by metagenomic next-generation sequencing. 
      INTERVENTIONS: The patient was treated with intravenous ganciclovir and 24 hours 
      later, the patient underwent exploratory laparotomy. Partial resection and 
      surgical repair of the small intestine were performed. OUTCOMES: The patient 
      ultimately died from intestinal obstruction and septic shock 55 days after 
      surgery. LESSONS: Perforations due to CMV-related IRIS are very rare, and usually 
      appear shortly after ART initiation. Most cases lack the prodromal symptoms of 
      abdominal pain and diarrhea. Intestinal perforations are lethal, and early 
      detection and surgical treatment are lifesaving.
CI  - Copyright (c) 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
FAU - Wang, Yanli
AU  - Wang Y
AD  - Infectious Diseases Department, The First Affiliated Hospital of China Medical 
      University, Shenyang, Liaoning Province, China.
FAU - Lin, Xuyong
AU  - Lin X
AD  - Pathology Department, The First Affiliated Hospital of China Medical University, 
      Shenyang, Liaoning Province, China.
FAU - Li, Yuji
AU  - Li Y
AD  - Gastrointestinal Surgery, The First Affiliated Hospital of China Medical 
      University, Shenyang, Liaoning Province, China.
FAU - Wen, Ying
AU  - Wen Y
AD  - Infectious Diseases Department, The First Affiliated Hospital of China Medical 
      University, Shenyang, Liaoning Province, China.
LA  - eng
GR  - 3110119068/the "double first-Class" university and discipline construction funds 
      of China Medical university/
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Anti-Retroviral Agents)
RN  - P9G3CKZ4P5 (Ganciclovir)
SB  - IM
MH  - Adult
MH  - Anti-Retroviral Agents/therapeutic use
MH  - Cytomegalovirus Infections/*complications
MH  - Ganciclovir/therapeutic use
MH  - HIV Infections/*complications/drug therapy
MH  - Humans
MH  - Immune Reconstitution Inflammatory Syndrome/*complications/drug therapy
MH  - Intestinal Perforation/*complications/therapy/virology
MH  - Male
PMC - PMC8284711
COIS- The authors have no conflicts of interest to disclose.
EDAT- 2021/07/15 06:00
MHDA- 2021/07/30 06:00
PMCR- 2021/07/16
CRDT- 2021/07/14 17:28
PHST- 2021/03/23 00:00 [received]
PHST- 2021/06/22 00:00 [accepted]
PHST- 2021/07/14 17:28 [entrez]
PHST- 2021/07/15 06:00 [pubmed]
PHST- 2021/07/30 06:00 [medline]
PHST- 2021/07/16 00:00 [pmc-release]
AID - 00005792-202107160-00027 [pii]
AID - MD-D-21-01948 [pii]
AID - 10.1097/MD.0000000000026605 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2021 Jul 16;100(28):e26605. doi: 
      10.1097/MD.0000000000026605.