valganciclovir and Chronic-Disease

A 54-year-old man presented with a 6-week history of chronic diarrhea and weight loss of 11 kg after returning from a holiday in Thailand. The patient had a 9-year history of an untreated HIV infection. Despite treatment of a culture-proven Shigella enteritis and strongyloidiasis the symptoms persisted. Finally, cytomegalovirus (CMV) colitis was diagnosed by colonoscopy. The patient recovered completely after starting antiretroviral and valganciclovir treatment. An additional opportunistic infection with multiresistant pulmonary tuberculosis was diagnosed.

Topics: Anti-Retroviral Agents; Chronic Disease; Colitis; Cytomegalovirus Infections; Diarrhea; Ganciclovir; HIV Infections; Humans; Male; Middle Aged; Thinness; Treatment Outcome; Valganciclovir; Weight Loss

Colectomy with ileoanal pouch formation is usually contraindicated in patients with Crohn's disease (CD) due to the risk of recurrent disease and pouch failure. We report the case of a patient, initially thought to have ulcerative colitis (UC), who underwent such surgery but subsequently developed perianal CD. She presented with diarrhoea and weight loss. Inflammatory markers were raised. Pouchoscopy revealed deep ulcers within the pouch. The main differential diagnoses were idiopathic pouchitis and recurrent CD. However, immunohistochemical staining demonstrated positivity for cytomegalovirus (CMV). Stool frequency, C reactive protein and albumin normalised within 48 h of starting oral valgancyclovir. At 15 weeks, pouch appearances were improved, no histological evidence of CMV was found and baseline pouch function had returned. This case highlights that CD can present many years after surgery for apparent UC. Also, CMV pouchitis should be considered as a differential cause of pouchitis especially as it is treatable with antiviral therapy.

Topics: Adult; Anal Canal; Anastomosis, Surgical; Antiviral Agents; Chronic Disease; Colectomy; Colitis, Ulcerative; Colonic Pouches; Crohn Disease; Cytomegalovirus; Cytomegalovirus Infections; Diarrhea; Endoscopy; Female; Ganciclovir; Humans; Inflammation; Postoperative Complications; Pouchitis; Proctocolectomy, Restorative; Ulcer; Valganciclovir; Weight Loss

To characterize a unique cytomegalovirus (CMV)-associated retinopathy in patients with limited immune dysfunction.. Retrospective observational case series. CMV was confirmed as the pathogenic agent via polymerase chain reaction analysis of aqueous or vitreous humor samples or via immunohistochemical analysis of retinal biopsy specimens.. Five non-HIV patients with granular necrotizing retinitis, vitritis, and severe occlusive vasculopathy were identified. Patient histories all suggested a basis for limited immune dysfunction including advanced age (n = 4), diabetes mellitus (n = 4), and noncytotoxic immunotherapy (n = 3). Diagnosis of CMV retinitis was delayed in all cases and patients received either no antiviral therapy (n = 2) or incorrect antiviral therapy (n = 3) for presumed herpes simplex/varicella zoster-related acute retinal necrosis. Retinitis subsequently regressed in all cases with introduction of systemic ganciclovir/valganciclovir (n = 5) and/or intravitreal foscarnet (n = 2). Four of five patients developed neovascularization because of extensive retinal ischemia.. The clinical expression of CMV-associated retinopathy is strongly related to immune status. In patients with limited immune dysfunction, a mixed clinical picture of intraocular inflammation with panretinal occlusive vasculopathy, more characteristic of acute retinal necrosis, and peripheral slowly progressive granular retinitis, more characteristic of classic CMV retinitis, is observed. Recognition of this atypical clinical presentation, which the authors term chronic retinal necrosis, should prompt molecular testing for CMV to determine the appropriate antiviral therapy. Consideration should also be given to prophylactic panretinal photocoagulation in such eyes, given the high risk of neovascular complications.

Topics: Aged; Aged, 80 and over; Antiviral Agents; Aqueous Humor; CD4 Lymphocyte Count; Chronic Disease; Cytomegalovirus; Cytomegalovirus Retinitis; DNA, Viral; Drug Therapy, Combination; Female; Foscarnet; Ganciclovir; HIV Seronegativity; Humans; Male; Middle Aged; Necrosis; Polymerase Chain Reaction; Retinal Neovascularization; Retinal Vasculitis; Retinal Vessels; Retrospective Studies; Uveitis, Posterior; Valganciclovir; Vitreous Body

To describe the diagnostic and therapeutic management of cytomegalovirus (CMV) anterior uveitis unassociated with retinal necrosis in immunocompetent patients.. Patients referred between 2001 and 2003 for management of unilateral, chronic, recurrent uveitis associated with secondary glaucoma underwent extensive investigation including laboratory tests for herpes virus infections. Specific antiviral treatment was initiated in all cases and the level of ocular inflammation was evaluated during the follow up.. Five patients, three men and two women, were included. Median age was 50 years old (range 30-80 years). Anterior unilateral uveitis without iris atrophy was observed in all cases. Uveitis was chronic in three cases and recurrent in two cases. Glaucoma was observed in all patients with a median intraocular pressure of 30 mm Hg (range 22-43 mm Hg). Five patients responded initially to specific anti-CMV therapy. Even though glaucoma surgery was necessary in two cases, both ocular inflammation and glaucoma were controlled in all cases. Relapses occurred in three cases after cessation of therapy, requiring prolonged maintenance therapy with valganciclovir.. CMV infection and specific antiviral therapy should be considered in all cases of relapsing or chronic iridocyclitis and secondary glaucoma. Maintenance regimens of valganciclovir may be necessary to prevent further relapses.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antiviral Agents; Chronic Disease; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Eye Infections, Viral; Female; Follow-Up Studies; Foscarnet; Ganciclovir; Glaucoma, Open-Angle; Gonioscopy; Humans; Iridocyclitis; Male; Middle Aged; Recurrence; Retrospective Studies; Uveitis, Anterior; Valganciclovir; Vitreous Body