Case Report
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2019; 25(15): 1899-1906
Published online Apr 21, 2019. doi: 10.3748/wjg.v25.i15.1899
Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation: A case report and review of literature
Takahiro Yokose, Hideaki Obara, Masahiro Shinoda, Yutaka Nakano, Minoru Kitago, Hiroshi Yagi, Yuta Abe, Yohei Yamada, Kentaro Matsubara, Go Oshima, Shutaro Hori, Sho Ibuki, Hisanobu Higashi, Yuki Masuda, Masanori Hayashi, Takehiko Mori, Miho Kawaida, Takumi Fujimura, Ken Hoshino, Kaori Kameyama, Tatsuo Kuroda, Yuko Kitagawa
Takahiro Yokose, Hideaki Obara, Masahiro Shinoda, Yutaka Nakano, Minoru Kitago, Hiroshi Yagi, Yuta Abe, Yohei Yamada, Kentaro Matsubara, Go Oshima, Shutaro Hori, Sho Ibuki, Hisanobu Higashi, Yuki Masuda, Masanori Hayashi, Takumi Fujimura, Ken Hoshino, Tatsuo Kuroda, Yuko Kitagawa, Department of Surgery, Keio University School of Medicine, Tokyo 1608582, Japan
Takehiko Mori, Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo 1608582, Japan
Miho Kawaida, Kaori Kameyama, Department of Pathology, Keio University School of Medicine, Tokyo 1608582, Japan
Author contributions: Obara H, Shinoda M, Yagi H, Matsubara K, Oshima G, Nakano Y, Ibuki S, Higashi H, Masuda Y, Hayashi M and Yokose T performed surgery. Yokose T wrote and coordinated this manuscript. Kitagawa Y, Kuroda T, Hoshino K, Kitago M, Abe Y, Yamada Y, Fujimura T and Hori S helped to draft the manuscript. Mori T helped to treatment especially cytomegalovirus infection and thrombotic microangiopathy. Kameyama K and Kawaida M performed pathological analysis. All authors read and approved the final manuscript.
Informed consent statement: Consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Hideaki Obara, MD, PhD, Associate Professor, Doctor, Surgeon, Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 1608582, Japan. obara.z3@keio.jp
Telephone: +81-3-33531211 Fax: +81-3-33554707
Received: January 11, 2019
Peer-review started: January 11, 2019
First decision: February 13, 2019
Revised: March 3, 2019
Accepted: March 15, 2019
Article in press: March 16, 2019
Published online: April 21, 2019
Abstract
BACKGROUND

Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT).

CASE SUMMARY

The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE.

CONCLUSION

This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.

Keywords: Cytomegalovirus gastrointestinal disease, Colon perforation, Antigenemia negative, Liver transplantation, Case report

Core tip: The cytomegalovirus (CMV) antigenemia (AG) test is useful for monitoring recipients for posttransplantation CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, most cases become positive during the disease course. We managed a patient with a complicated condition with a transverse colon perforation caused by AG-negative CMV gastroenteritis, after a living donor liver transplantation. This case report presents a method that could be important monitoring for AG-negative CMV gastroenteritis after solid-organ transplantation.