A rare complication of CMV infection in Crohns disease - hemophagocytic syndrome: a case report

Vol. 56 No. 4, 2015

ROMANIAN JOURNAL of MORPHOLOGY and EMBRYOLOGY

Corina Silvia Pop, Gabriel Becheanu, Dorina Calagiu, Petruta-Violeta Jantea, Dragos Mihai Radulescu, George Pariza, Carmen-Iuliana Mavrodin, Adriana Bold, Adrian Costache, Roxana Maria Nemes

We report a case of CMV (cytomegalovirus) infection in a Crohns disease patient, resulting in severe hemophagocytic syndrome and death. A 63-year-old man with a 10-year history of ileal and colonic Crohns disease presented with general malaise, loss of appetite and weight loss over the last month. He was in clinical remission for two years, with maintenance therapy 5-Aminosalicylic acid (5-ASA)-derived Mesalamine. The patient had no prior immunomodulators or suppressive treatment. A colonoscopy was performed and we found appearance suggestive of active Crohns disease, confirmed by histopathological examination. A diagnosis of an exacerbation of Crohns disease was established. Although the specific treatment was initiated, patients general condition degraded progressively and diarrheal stools appeared, followed by an episode of massive gastrointestinal bleeding - hematochezia. We performed a new colonoscopy and the pathological examination revealed Crohns ileocolitis with superimposed CMV infection. Despite the initiation of Ganciclovir alongside with other intensive care measures, he increasingly deteriorated and chest X-ray confirmed multilobar pneumonia. The occurrence of rapidly progressing pancytopenia and evidence for disseminated intravascular coagulopathy as well as hyperferritinemia, raised the suspicion of hemophagocytic syndrome confirmed by bone marrow aspiration. Hence, CMV-associated hemophagocytic syndrome in the context of recent corticotherapy for Crohns disease was established. There is enough evidence that supports the gravity of the CMV infection in the case of inflammatory bowel disease (IBD) patients, especially the ones on immunomodulator treatment. The hemophagocytic syndrome reactively occurs in patients with infections in cases of immunodeficiency, displaying a hematological aspect of multiple organ dysfunction syndrome.

Corresponding author: Adrian Costache, Associate Professor, MD, PhD; e-mail: adriancostacheeco@yahoo.com

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