valganciclovir and Weight-Loss

We present the case of a 28-year-old man with recently-diagnosed human immunodeficiency virus and hepatitis C virus infection. He developed obstructive cholangiopathy secondary to cytomegalovirus and Kaposi sarcoma, both diagnosed by endoscopic retrograde cholangiopancreatography and biopsies. He received antiretroviral therapy, chemotherapy and valganciclovir with full recovery.

Topics: Abdominal Pain; Adult; AIDS-Related Opportunistic Infections; Antiretroviral Therapy, Highly Active; Bile Duct Diseases; Biopsy; Cholangiopancreatography, Endoscopic Retrograde; Cytomegalovirus; Diarrhea; Fever; Hepatitis C; HIV Infections; Humans; Male; Sarcoma, Kaposi; Valganciclovir; Weight Loss

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