| Abstrakt: |
Cytomegalovirus (CMV) infection can lead to localized or disseminated disease in patients with severe immunosuppression. Most clinical CMV-related diseases are a result of viral reactivation. In patients with human immunodeficiency virus (HIV) infection, end-organ diseases due to CMV infection are usually seen when CD4+ T lymphocyte counts <50 cells/mm³. Herein, we reported a case of CMV enteritis in a patient with HIV infection. A 53-year-old man came to our hospital with intractable duodenal ulcer for 6 months. Patient suffered from persistent heartburn unrelated to food intake, along with anorexia, which led to a 15 kg weight loss. After the initial outpatient visit, the patient was diagnosed with HIV infection (serum HIV RNA 2,900,000 copies/mL; CD4+ T lymphocyte cell count 42 cells/mm3 ). An esophagogastroduodenoscopy (EGD) showed deep duodenal ulcers, and the pathology confirmed CMV duodenitis with ulceration [Figure 1]. After the admission, the patient was treated with intravenous ganciclovir, along with oral bictegravir/emtricitabine/tenofovir/alafenamide and trimethoprim-sulfamethoxazole for HIV. However, after three days of hospitalization, the patient developed severe abdominal pain with fever. X-ray and CT scan revealed pneumoperitoneum, suggesting small bowel perforation [Figure 2], which required emergent surgical intervention. Intraoperative findings revealed a perforated jejunal ulcer, necessitating segmental small bowel resection and anastomosis. The gross specimen showed multiple deep ulcers, and final pathology revealed diffuse large B cell lymphoma alongside CMV enteritis with ulcers [Figure 3]. The patient recovered successfully after surgery and continues to receive HIV treatment.CMV enteritis is a relatively rare form of CMV infection, but it can lead to perforation and be fatal in patients with severe immunosuppression, such as those with HIV. The simultaneous occurrence of CMV enteritis and diffuse large B-cell lymphoma in our HIV-infected patient underscores the importance of comprehensive evaluation and multidisciplinary management. [ABSTRACT FROM AUTHOR] |
