CMV Colitis: A Rare Complication of Azacitidine and Venetoclax Chemotherapy

Abstract

Herein, we present a case of cytomegalovirus (CMV) colitis that occurred after two cycles of azacitidine and venetoclax in a 64-year-old woman affected with acute myeloid leukaemia (AML) secondary to a previous diagnosis of a hypoplastic myelodysplastic syndrome (hypo-MDS). This patient never had detectable CMV viraemia, and there was no evidence of immune deficiency that could justify this opportunistic infection. Additionally, this is most likely the first report describing CMV colitis in a patient treated upfront with azacitidine and venetoclax.

Keywords: AML; CMV; venetoclax.

Figure 1

(A) Selected coronal CT image, acquired in the portal venous phase, shows marked bowel wall thickening and mucosal hyperenhancement in the ascending colon (blue arrow), descending colon (orange arrows), and sigmoid colon (green arrow), in agreement with the diagnosis of active multifocal colitis; (B) selected axial CT image, acquired in the portal venous phase, shows marked bowel wall thickening and mucosal hyperenhancement in the hepatic flexure of the large bowel (blue arrow) and splenic flexure of the large bowel (orange arrow), in agreement with the diagnosis of active multifocal colitis; (C) selected axial CT image, acquired in the portal venous phase, shows marked bowel wall thickening and mucosal hyperenhancement in the descending colon (orange arrow), in agreement with the diagnosis of active colitis.

Figure 2

From mid-descending colon to rectum (A–F): There was a continuous superficial inflammation. Loss of vascular pattern occurred throughout. Aphthous ulcers were seen but only superficially.

Figure 3

From rectum to splenic flexure (A–D): findings of proctocolitis, however, improved compared with previous sigmoidoscopy.

Figure 4

Timeline of events.

Figure 5

Naranjo Adverse Drug Reaction Probability Scale (Taken and adapted from www.evidencio.com/models/show/661, accessed on 8 March 2022).