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Acute gastrointestinal graft-versus-host disease with CMV and EBV superinfection
Acute gastrointestinal graft-versus-host disease with CMV and EBV superinfection
Ana Raquel Gonçalves, Emanuel Dias , Margarida Marques , Susana Lopes , Irene Gullo , Juliana Bastos, Guilherme Macedo
Centro Hospitalar Universitário de São João
A 60-year-old female with previous history of hematopoietic stem cell transplantation for acute myeloid leukemia was admitted with diarrhea, abdominal pain, fever and acute kidney injury. Both cytomegalovirus (CMV) and Epstein-Barr virus (EBV) were detected in peripheral blood. Sigmoidoscopy showed edema, erythema and loss of vascular pattern with interspersed segments of mucosal denudation and exudate. Biopsies revealed epithelial cell apoptosis, diffuse crypt atrophy and dropout with ulceration and positivity for CMV and EBV, consistent with acute severe gastrointestinal graft-versus-host disease complicated by CMV and EBV superinfection. Despite starting therapy with methylprednisolone, ganciclovir and rituximab, she would die after 5 weeks.
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