Disseminated Cytomegalovirus Infection and Protein Losing Enteropathy as Presenting Feature of Pediatric Patient with Crohn’s Disease
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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 man-agement, antiviral therapy, the clinical condition of the patient worsened and developed disseminated cytomegalovi-rus infection and the patient died. Protein losing enteropathy and disseminated cytomegalovirus infection a present-ing of feature in steroid-naive patient with inflammatory bowel disease is very rare. Hypogammaglobulinemia asso-ciated with protein losing enteropathy in Crohn's disease may predispose the cytomegalovirus infection in previously healthy children.
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 man-agement, antiviral therapy, the clinical condition of the patient worsened and developed disseminated cytomegalovi-rus infection and the patient died. Protein losing enteropathy and disseminated cytomegalovirus infection a present-ing of feature in steroid-naive patient with inflammatory bowel disease is very rare. Hypogammaglobulinemia asso-ciated with protein losing enteropathy in Crohn's disease may predispose the cytomegalovirus infection in previously healthy children.
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