CMV-Enterokolitis bei einer erwachsenen lebertransplantierten Patientin als Ursache rezidivierender Invaginationen?

 

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Zusammenfassung

Die intestinale Invagination beim Erwachsenen tritt sowohl idiopathisch als auch im Zusammenhang mit chronisch entzündlichen Darmerkrankungen, der Sprue, Tumoren und nach abdominellen Operationen auf. Eine aufgrund eines Crigler-Najar-Syndroms lebertransplantierte 22-jährige Patientin beklagte seit Monaten rezidivierende Episoden abdomineller Schmerzen. Computertomografisch und sonografisch gelang der Nachweis spontaner, im Verlauf selbstlimitierender intestinaler Invaginationen. Eine Laparoskopie erbrachte keine Ursache für die Invaginationen. Bei einem erneuten Rezidiv der bekannten Symptomatik zeigte sich in einer Koloskopie das Bild einer leichtgradigen Kolitis. Aus den entnommenen Kolonbiopsien gelang mittels qualitativer PCR der Nachweis des Zytomegalie-Virus (CMV), während die Blutuntersuchung auf CMV-pp65-Antigen negativ war. Mittels einer Gancyclovir-Therapie wurde die chronische enterale CMV-Infektion erfolgreich behandelt. Eine Verlaufskoloskopie nach 6 Wochen erbrachte ein unauffälliges Schleimhautbild ohne bioptischen CMV-Nachweis. Im Verlauf unterblieben erneute Invaginationen. Eine chronische enterale CMV-Infektion könnte beim immunsupprimierten Patienten eine mögliche Ursache rezidivierender Invaginationen zu sein. Zum Nachweis einer intestinalen CMV-Infektion beim immunsupprimierten Patienten sollte, wenn möglich, der virologische Nachweis aus Kolonbiopsien per PCR eingesetzt werden, da CMV pp65 und Immunhistochemie in unserem Fall negativ waren.

Abstract

Intestinal intussusception in the adult is often idiopathic but also known to be associated with chronic inflammatory bowel disease, coeliac disease, tumours or previous abdominal operations. A 22-year-old women after liver transplantation due to Crigler Najar Syndrom suffered from repeated episodes of abdominal pain. The diagnosis of repeated self-limited intestinal intussusceptions was made by computed tomography and ultrasonography. A laparoscopy revealed no cause for the intussusceptions. During a new episode of abdominal pain caused again by an intussusception a colonoscopy was performed that showed aspects of a discreet colitis. In the biopsies CMV was detected by qualitative PCR, while blood tests for CMV pp65 antigen were negative. A therapy with gancyclovir was initiated which lead to remission of the patienti's symptoms. A colonoscopy six weeks later showed a completely normal colon, while in the biopsies CMV was not detectable. After a follow-up of one year the patient has not suffered from any further episodes. This case demonstrates the role of chronic intestinal CMV infection as a possible causative factor for repeated intussusceptions in immunosuppressed patients. Whenever possible a PCR for CMV in colon biopsies should be carried out to detect an intestinal CMV infection because as shown in our case results for immunohistopathology and CMV pp65 can be negative despite a chronic infection.

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Dr. Sven Pischke

Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover

Carl-Neuberg-Straße 1

30625 Hannover

Email: pischke.sven@mh-hannover.de