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Case Reports
. 2024 Jul 20;16(7):e64986.
doi: 10.7759/cureus.64986. eCollection 2024 Jul.

Clinical Diagnosis of Cytomegalovirus Colitis Enhanced With Multiplex Polymerase Chain Reaction Panel Using Stool Sample: A Case Report

Shinobu Hosokawa  1 , Akihiro Bessho  1 , Mai Kagawa  2 , Masahiro Oda  2 , Makoto Sakugawa  1
Affiliations
Case Reports

Clinical Diagnosis of Cytomegalovirus Colitis Enhanced With Multiplex Polymerase Chain Reaction Panel Using Stool Sample: A Case Report

Shinobu Hosokawa et al. Cureus. .

Abstract

A 71-year-old man was admitted because of acute exacerbation of interstitial pneumonia following a right upper lobectomy for lung cancer. His respiratory failure worsened after admission, and he required mechanical ventilation. He was undergoing intensive immunosuppressive treatment, including high-dose corticosteroids and cyclosporine, and had watery diarrhea six times a day. White blood cells were found in the stool, and an intestinal infection was suspected. Fecal cultures showed no pathogenic bacteria. Multiplex polymerase chain reaction for gastrointestinal infection yielded negative results. Based on the increasing number of cytomegalovirus (CMV) antigen-positive cells in the CMV antigenemia assay, we suspected CMV colitis. However, the patient was still undergoing mechanical ventilation, and colonoscopy was difficult to perform. After explaining the procedure to the patient and obtaining his consent, the BioFire® FilmArray® Meningitis/Encephalitis (ME) Panel was performed using a fecal specimen. CMV was detected. Intravenous infusion of ganciclovir at 5 mg/kg was immediately commenced and administered every 12 hours for three weeks. Intravenous infusion at 5 mg/kg was continued every 24 hours thereafter for a further three weeks. When CMV colitis is suspected but the patient's condition prevents tissue collection through colonoscopy and standard diagnosis by histopathology, the addition of CMV PCR using a stool sample may assist in the clinical diagnosis of CMV colitis. The use of multiplex polymerase chain reaction is expected to contribute to prompt and appropriate treatment.

Keywords: cmv pcr; cytomegalovirus colitis; immunosuppression; multiplex pcr; stool.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Akihiro Bessho declare(s) a grant from MSD K.K. Akihiro Bessho declare(s) personal fees from Pfizer Inc. / MSD K.K. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Clinical course
CMV Ag, cytomegalovirus antigen; CMV-PCR, cytomegalovirus-polymerase chain reaction; MINO, minocycline hydrochloride; mPSL, methylprednisolone; PSL, prednisolone; SBT/ABPC, sulbactam sodium/ampicillin sodium; TAZ/PIPC, tazobactam/piperacillin hydrate
See this image and copyright information in PMC

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