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Hemophagocytic Syndrome Caused by Fulminant Ulcerative Colitis and Cytomegalovirus Infection: Report of a Case

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Diseases of the Colon & Rectum

We report a case of hemophagocytic syndrome that developed in a 35-year-old, Japanese male with fulminant ulcerative colitis. The patient underwent an emergency operation, consisting of subtotal colectomy, ileostomy with rectal preservation (suprapubic mucous fistula). After the operation, peripheral blood counts showed progressive pancytopenia and bone marrow aspirate smears revealed hypocellular bone marrow with an increase in histiocytes, indicating hemophagocytic syndrome. Viral studies (serum antibody titer and antigenemia of cytomegalovirus) revealed systemic cytomegalovirus infection. The patient was diagnosed with virus-associated hemophagocytic syndrome and was successfully treated with antiviral therapy consisting of intravenous ganciclovir, gamma globulin, and granulocyte-colony stimulating factor.

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REFERENCES

To the article

  1. R Vega X Bertran M Menacho et al. (1999) ArticleTitleCytomegalovirus infection in patients with inflammatory bowel disease Am J Gastroenterol 94 1053–6

    Google Scholar 

  2. HS Kaufman AC Kahn C Iacobuzio-Donahue MA Talamini KD Lillemoe SR Hamilton (1999) ArticleTitleCytomegaloviral enterocolitis: clinical associations and outcome Dis Colon Rectum 42 24–30

    Google Scholar 

  3. DG Begos R Rappaport D Jain (1996) ArticleTitleCytomegalovirus infection masquerading as an ulcerative colitis flare-up: case report and review of the literature Yale J Biol Med 69 323–8

    Google Scholar 

  4. C Rachima E Maoz S Apter M Thaler E Grossman T Rosenthal (1998) ArticleTitleCytomegalovirus infection associated with ulcerative colitis in immunocompetent individuals Postgrad Med J 74 486–91

    Google Scholar 

  5. S Imashuku (1997) ArticleTitleDifferential diagnosis of hemophagocytic syndrome: underlying disorders and selection of the most effective treatment Int J Hematol 66 135–51

    Google Scholar 

  6. KF Wong JK Chan (1992) ArticleTitleReactive hemophagocytic syndrome- a clinicopathologic study of 40 patients in an Oriental population Am J Med 93 177–80

    Google Scholar 

  7. BE Favara (1992) ArticleTitleHemophagocytic lymphohistiocytosis: a hemophagocytic syndrome Semin Diagn Pathol 9 63–74

    Google Scholar 

  8. H Tsuda (1997) ArticleTitleHemophagocytic syndrome (HPS) in children and adults Int J Hematol 65 215–26

    Google Scholar 

  9. RJ Risdall RW McKenna ME Nesbit et al. (1979) ArticleTitleVirus-associated hemophagocytic syndrome: a benign histiocytic proliferation distinct from malignant histiocytosis Cancer 44 993–1002

    Google Scholar 

  10. GA Nankervis ML Kumar (1978) ArticleTitleDiseases produced by cytomegaloviruses Med Clin North Am 62 1021–35

    Google Scholar 

  11. RW Goodgame (1993) ArticleTitleGastrointestinal cytomegalovirus disease Ann Intern Med 119 924–35

    Google Scholar 

  12. ZD Goodman JK Boitnott JH Yardley (1979) ArticleTitlePerforation of the colon associated with cytomegalovirus infection Dig Dis Sci 24 376–80

    Google Scholar 

  13. M Cottone G Pietrosi G Martorana et al. (2001) ArticleTitlePrevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn’s colitis Am J Gastoenterol 96 773–5

    Google Scholar 

  14. T Berk SJ Gordon HY Choi HS Cooper (1985) ArticleTitleCytomegalovirus infection of the colon: a possible role in exacerbations of inflammatory bowel disease Am J Gastroenterol 80 355–60

    Google Scholar 

  15. K Kaito M Kobayashi T Katayama et al. (1997) ArticleTitlePrognostic factors of hemophagocytic syndrome in adults: analysis of 34 cases Eur J Haematol 59 247–53

    Google Scholar 

  16. P Chandra SA Chaudhery F Rosner M Kagen (1975) ArticleTitleTransient histiocytosis with striking phagocytosis of platelets, leukocytes, and erythrocytes Arch Intern Med 135 989–91

    Google Scholar 

To the Invited Commentary

  1. Anon. Cytomegalovirus (CMV) infection. Centers for Disease Control, 2003.

  2. EV Loftus SuffixJr GL Alexander HA Carpenter (1994) ArticleTitleCytomegalovirus as an exacerbating factor in ulcerative colitis J Clin Gastroenterol 19 306–9

    Google Scholar 

  3. M Munoz-Juarez JH Pemberton WJ Sandborn et al. (1999) ArticleTitleMisdiagnosis of specific cytomegalovirus infection of the ileoanal pouch as refractory idiopathic chronic pouchitis: report of two cases Dis Colon Rectum 42 117–20

    Google Scholar 

  4. D Helbling TH Breitbach M Krause (2002) ArticleTitleDisseminated cytomegalovirus infection in Crohn’s disease following anti-tumour necrosis factor therapy Eur J Gastroenterol Hepatol 14 1393–5

    Google Scholar 

  5. S Kanaji K Okuma Y Tokumitsu et al. (1998) ArticleTitleHemophagocytic syndrome associated with fulminant ulcerative colitis and presumed acute pancreatitis Am J Gastroenterol 93 1956–9

    Google Scholar 

To the Authors Reply

  1. S Humblot T Martin JL Pasquali AS Korganow (2001) ArticleTitleBlood coagulation disorders during primary cytomegalovirus infection Arch Intern Med 161 2149–50

    Google Scholar 

  2. M Shinozaki T Masaki T Muto (1997) ArticleTitleCytomegalic colitis after total colectomy in ulcerative colitis: report of a case Dis Colon Rectum 40 1124–7

    Google Scholar 

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Correspondence to Shin-ichiro Koketsu M.D..

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Koketsu, Si., Watanabe, T., Hori, N. et al. Hemophagocytic Syndrome Caused by Fulminant Ulcerative Colitis and Cytomegalovirus Infection: Report of a Case. Dis Colon Rectum 47, 1250–1255 (2004). https://doi.org/10.1007/s10350-004-0543-x

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  • DOI: https://doi.org/10.1007/s10350-004-0543-x

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