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Cytomegalovirus associated colonic pseudotumor: a consequence of iatrogenic immunosuppression in a patient with primary brain tumor receiving radiation and temozolomide

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Abstract

We report the case of a patient with primary brain tumor who developed cytomegalovirus associated colonic pseudotumor as an opportunistic infection while receiving chemotherapy with Temozolomide and radiation. This case highlights the potential for severe opportunistic infections in this patient population after severe immunosuppression.

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References

  1. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352:987–996. doi:10.1056/NEJMoa043330

    Article  PubMed  CAS  Google Scholar 

  2. Su YB, Sohn S, Krown SE, Livingston PO, Wolchok JD, Quinn C, Williams L, Foster T, Sepkowitz KA, Chapman PB (2004) Selective CD4+ lymphopenia in melanoma patients treated with temozolomide: a toxicity with therapeutic implications. J Clin Oncol 22:610–616. doi:10.1200/JCO.2004.07.060

    Article  PubMed  CAS  Google Scholar 

  3. Rich JD, Crawford JM, Kazanjian SN, Kazanjian PH (1992) Discrete gastrointestinal mass lesions caused by cytomegalovirus in patients with AIDS: report of three cases and review. Clin Infect Dis 15:609–614

    PubMed  CAS  Google Scholar 

  4. Lewis-Jones HG, Ward RG, Garvey C (1990) Cytomegalovirus infection masquerading as colonic neoplasia. Br J Radiol 63:573–574

    Article  PubMed  CAS  Google Scholar 

  5. Wisser J, Zingman B, Wasik M, Duva-Frissora A, Beazley R, McAneny D (1992) Cytomegalovirus pseudotumor presenting as bowel obstruction in a patient with acquired immunodeficiency syndrome. Am J Gastroenterol 87:771–774

    PubMed  CAS  Google Scholar 

  6. Swansiger B, Orchard JL (1996) A colonic mass lesion due to cytomegalovirus in an immunocompromised patient. J Clin Gastroenterol 22:41–44. doi:10.1097/00004836-199601000-00012

    Article  PubMed  CAS  Google Scholar 

  7. Falagas ME, Griffiths J, Prekezes J, Worthington M (1996) Cytomegalovirus colitis mimicking colon carcinoma in an HIV-negative patient with chronic renal failure. Am J Gastroenterol 91:168–169

    PubMed  CAS  Google Scholar 

  8. Chow PK, Ho JM, Ling AE, Goh HS (1997) CMV colitis masquerading as colon cancer—an unusual presentation of acquired immunodeficiency syndrome. Singapore Med J 38:32–34

    PubMed  CAS  Google Scholar 

  9. Diaz-Gonzalez VM, Altemose GT, Ogorek C, Palazzo I, Pina IL (1997) Cytomegalovirus infection presenting as an apple-core lesion of the colon. J Heart Lung Transplant 16:1171–1175

    PubMed  CAS  Google Scholar 

  10. Crespo MG, Arnal FM, Gomez M, Monserrat L, Suarez F, Rodriguez JA, Paniagua MJ, Cuesta M, Juffe A, Castro-Beiras A (1998) Cytomegalovirus colitis mimicking a colonic neoplasm or ischemic colitis 4 years after heart transplantation. Transplantation 66:1562–1565. doi:10.1097/00007890-199812150-00023

    Article  PubMed  CAS  Google Scholar 

  11. Goyal RS, Goyal SB (2000) Cytomegalovirus infection in AIDS presenting as a rectal mass. Am J Gastroenterol 95:327–328. doi:10.1111/j.1572-0241.2000.01410.x

    Article  PubMed  CAS  Google Scholar 

  12. Maiorana A, Torricelli P, Giusti F, Bellini N (2003) Pseudoneoplastic appearance of cytomegalovirus-associated colitis in nonimmunocompromised patients: report of 2 cases. Clin Infect Dis 37:e68–e71. doi:10.1086/375876

    Article  PubMed  Google Scholar 

  13. Napierkowski JJ, Sachar DS, Cumings M, Kaplan K, Wong RK (2003) Image of the month. Cytomegalovirus (CMV) colitis. Gastroenterology 125(8):281

    Google Scholar 

  14. Grossman SA, Desideri S, Ye X, Szajna K, Chamberlain M, Lesser G (2007) Iatrogenic immunosuppression in patients with newly diagnosed high-grade gliomas. In: 2007 ASCO annual meeting abstract no. 2012

  15. Fauci AS, Dale DC, Balow JE (1976) Glucocorticosteroid therapy: mechanisms of action and clinical considerations. Ann Intern Med 84:304–315

    PubMed  CAS  Google Scholar 

  16. Hughes MA, Parisi M, Grossman S, Kleinberg L (2005) Primary brain tumors treated with steroids and radiotherapy: low CD4 counts and risk of infection. Int J Radiat Oncol Biol Phys 62:1423–1426. doi:10.1016/j.ijrobp.2004.12.085

    PubMed  CAS  Google Scholar 

  17. Kleinberg L, Grossman SA, Piantadosi S, Zeltzman M, Wharam M (1999) The effects of sequential versus concurrent chemotherapy and radiotherapy on survival and toxicity in patients with newly diagnosed high-grade astrocytoma. Int J Radiat Oncol Biol Phys 44:535–543. doi:10.1016/S0360-3016(99)00060-7

    Article  PubMed  CAS  Google Scholar 

  18. Brock CS, Newlands ES, Wedge SR, Bower M, Evans H, Colquhoun I, Roddie M, Glaser M, Brampton MH, Rustin GJ (1998) Phase I trial of temozolomide using an extended continuous oral schedule. Cancer Res 58:4363–4367

    PubMed  CAS  Google Scholar 

  19. Stupp R, Dietrich PY, Ostermann Kraljevic S, Pica A, Maillard I, Maeder P, Meuli R, Janzer R, Pizzolato G, Miralbell R, Porchet F, Regli L, de Tribolet N, Mirimanoff RO, Leyvraz S (2002) Promising survival for patients with newly diagnosed glioblastoma multiforme treated with concomitant radiation plus temozolomide followed by adjuvant temozolomide. J Clin Oncol 20:1375–1382. doi:10.1200/JCO.20.5.1375

    Article  PubMed  CAS  Google Scholar 

  20. Hwu WJ, Lis E, Menell JH, Panageas KS, Lamb LA, Merrell J, Williams LJ, Krown SE, Chapman PB, Livingston PO, Wolchok JD, Houghton AN (2005) Temozolomide plus thalidomide in patients with brain metastases from melanoma: a phase II study. Cancer 103:2590–2597. doi:10.1002/cncr.21081

    Article  PubMed  CAS  Google Scholar 

  21. Schwarzberg AB, Stover EH, Sengupta T, Michelini A, Vincitore M, Baden LR, Kulke MH (2007) Selective lymphopenia and opportunistic infections in neuroendocrine tumor patients receiving temozolomide. Cancer Invest 25:249–255. doi:10.1080/07357900701206380

    Article  PubMed  CAS  Google Scholar 

  22. Cobbs CS, Harkins L, Samanta M, Gillespie GY, Bharara S, King PH, Nabors LB, Cobbs CG, Britt WJ (2002) Human cytomegalovirus infection and expression in human malignant glioma. Cancer Res 62:3347–3350

    PubMed  CAS  Google Scholar 

  23. Mitchell DA, Xie W, Schmittling R, Learn C, Friedman A, McLendon RE, Sampson JH (2008) Sensitive detection of human cytomegalovirus in tumors and peripheral blood of patients diagnosed with glioblastoma. Neurooncology 10:10–18. doi:10.1215/15228517-2007-035

    Google Scholar 

  24. Mahindra AK, Grossman SA (2003) Pneumocystis carinii pneumonia in HIV negative patients with primary brain tumors. J Neurooncol 63:263–270. doi:10.1023/A:1024217527650

    Article  PubMed  Google Scholar 

  25. Sepkowitz KA, Brown AE, Telzak EE, Gottlieb S, Armstrong D (1992) Pneumocystis carinii pneumonia among patients without AIDS at a cancer hospital. JAMA 267:832–837. doi:10.1001/jama.267.6.832

    Article  PubMed  CAS  Google Scholar 

  26. Ganiere V, Christen G, Bally F, Guillou L, Pica A, de Ribaupierre S, Stupp R (2006) Listeria brain abscess, Pneumocystis pneumonia and Kaposi’s sarcoma after temozolomide. Nat Clin Pract Oncol 3:339–343 quiz following 343, 2006

    Article  PubMed  Google Scholar 

  27. Choi JD, Powers CJ, Vredenburgh JJ, Friedman AH, Sampson JH (2008) Cryptococcal meningitis in patients with glioma: a report of two cases. J Neurooncol 89:51–53. doi:10.1007/s11060-008-9581-x

    Article  PubMed  Google Scholar 

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Correspondence to Ana De Jesus.

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De Jesus, A., Grossman, S.A. & Paun, O. Cytomegalovirus associated colonic pseudotumor: a consequence of iatrogenic immunosuppression in a patient with primary brain tumor receiving radiation and temozolomide. J Neurooncol 94, 445–448 (2009). https://doi.org/10.1007/s11060-009-9882-8

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  • DOI: https://doi.org/10.1007/s11060-009-9882-8

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