Abstract
Acute CMV infection in the immunocompetent host is usually asymptomatic or produces only mild symptoms. CMV infection in immunocompromized patients, especially transplant recipients and those infected with HIV, is a result of profound lymphopenia or dysfunction of CD4+/CD8+ cells and can cause substantial rates of complication and death. We present a case of CMV infection in a previously healthy man who just had splenectomy for blunt trauma: a short incubation of the CMV disease, a strongly positive CMV antigenemia, severity of the disease including prominent lymphocytosis, massive hepatic sinusoidal infiltration, and retinitis. Splenectomy changed the immunological defense against the virus and brought the infection to nearly fulminant scale.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Whitcup SM (2000) Cytomegalovirus retinitis in the era of highly active retroviral therapy. JAMA 283:653–657
Slifkin M, Tempesti P, Poutsiaka DD, Snydman DR (2001) Late and atypical cytomegalovirus disease in solid organ transplant recipients. Clin Infect Dis 33:62–68
Zawilinska B, Weglarska D, Gruszka AM, Skotnicki AB, Zgorniak-Nowosielska I (1996) The frequency of cytomegalovirus infection in immunocomromised patients with malignant and non malignant blood disorder. Acta Haematol Pol 27:65–71
Gandhi MK, Khanna R (2004) Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis 4:725–738
Amory J, Rosen H, Sukut C, Wallace F, Saint S (2006) A jaundiced eye. N Engl J Med 354:1516–1520
Cohen JI, Corey GR (1985) Cytomegalovirus infection in the normal host. Medicine (Baltimore) 64:100–114
Ina S, Tani M, Takifuji K, Yamazoe S, Nakatani Y, Yamaue H (2004) Virus-associated hemophagocytic syndrome and hemorrhagic jejunal ulcer caused by cytomegalovirus infection in a non compromised host: a case report of unusual entity. Hepatogastroenterology 51:491–493
Alliot C, Beets C, Besson M, Derolland P (2001) Spontaneous splenic rupture associated with CMV infection: report of a case and review. Scan J Infect Dis 33:875–877
Sakai C, Kumagai K, Takagi T (2000) Clinical features of 25 patients with cytomegalovirus infection complicating hematological diseases unrelated to allogenic bone marrow transplantation. Kansenshogaku Zasshi 74:215–220
Vote B, Russel M, Polkinghorne P (2005) Recurrent cytomegalovirus retinitis in a patient with a normal lymphocyte count who had undergone splenectomy for lymphoma. Retina 25:220–221
Han XY, Lin P, Amin HM, Ferrajoli A (2005) Postsplenectomy cytomegalovirus mononucleosis: marked lymphocytosis, TCR gamma gene rearrangement, and impaired IgM response. Am J Clin Pathol 123:612–617
Baumgartner JD, Glauser MP, Burgo-Black AL, Black RD, Pyndiah N, Chiolero R (1982) Severe cytomegalovirus infection in multiply transfused splenectomized trauma patients. Lancet 2(8298):63–66
Stein J, Volk HD, Liebental C, Kruger DH, Prosh S (1993) Tumor necrosis factor alpha stimulates the activity of the human cytomegalovirus major immediate early enhancer/promoter in immature monocytic cells. J Gen Virol 74:2333–2338
Wolf HM, Eibl MM, Georgi E, Samstag A, Spatz M, Uranus S, Passl R (1999) Longterm decrease of CD4+ CD45RA+ T cells and impaired primary immune response after posttraumatic splenectomy. Br J Haematol 107:55–68
Bohnsack JF, Brown EJ (1986) The role of the spleen in resistance to infection. Ann Rev Med 37:49–59
Miniello S, Testini M, Jirillo E, Piccinni G, Urgesi G, Lissidini G, Angrisano A, Tomasicchio N, Bonomo GM (2002) Postsplenectomy immunodepression and its implication: an underestimated problem. Surg 87:245–251
Lopez-Botet M, Angulo A, Guma M (2004) Natural killer cell receptors for major histocomptability complex class I and related molecules in cytomegalovirus infection. Tissue Antigens 63:195–203
Kruetzmann S, Rosado MM, Weber H, Germing U, Tournilhac O, Peter HH, Berner R, Peters A, Boehm T, Plebani A, Quinti I, Carsetti R (2003) Human immunoglobulin M memory B cells controlling Streptococcus pneumonia infections rate generated in the spleen. J Exp Med 197:939–945
Kanj SS, Sharara AI, Clavien PA, Hamilton JD (1996) Cytomegalovirus infection following liver transplantation: review of the literature. Clin Infectious Dis 22:537–549
Acknowledgments
We obtained a consent form from the patient for publication of this case.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Assy, N., Gefen, H., Schlesinger, S. et al. Reactivation versus Primary CMV Infection after Splenectomy in Immunocompetent Patients. Dig Dis Sci 52, 3477–3480 (2007). https://doi.org/10.1007/s10620-006-9712-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-006-9712-1