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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Viral acute pancreatitis in Human Immunodeficiency Virus (HIV) infected patients has been occasionally described. We studied nine patients with HIV antibodies and acute pancreatitis attributed to Cytomegalovirus and/or Cryptosporidium infection. In four patients the clinical picture was consistent with acute pancreatitis while in five clinical manifestations were unspecific, and diagnosis was based on ultrasonography and/or computed tomography findings. In the HIV infected patient pancreatic evaluation by imaging techniques may disclose acute pancreatitis even in the absence of abdominal pain.
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PMID:[Acute pancreatitis and acquired immunodeficiency syndrome]. 866 74

68-year-old woman presented with abdominal pain and vomiting. After initial conservative therapy, laparotomy showed multiple ulcers of the ileum, one of which had perforated and adhered to the uterus. The affected segment of the ileum was resected. Numerous cytomegalic cells, corresponding to endothelia and macrophages, with intranuclear inclusion bodies, were found in microscopic sections of the ulcerated lesions. These findings were consistent with cytomegalic vasculitis and enteritis. Cytomegalovirus infections of the alimentary tract have been reported mainly in severely immunocompromised patients or those with predisposing disorders such as ulcerative colitis; their prognosis is usually poor. In our patient, there was no obvious immunocompromised state or other gastrointestinal disorders. The postoperative course has been uneventful for 2 years after surgery. The prognosis of Cytomegalovirus-associated lesions in the alimentary tract may be quite good in the immunocompetent patient.
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PMID:Multiple ulcers of the ileum due to Cytomegalovirus infection in a patient who showed no evidence of an immunocompromised state. 925 Sep 6

Cytomegalovirus (CMV) infection occurs predominantly in immunocompromised hosts. Involvement of the gastrointestinal tract in acquired immunodeficiency syndrome (AIDS) patients is frequent. Nevertheless, CMV appendicitis is exceeding rare. This report describes a patient with AIDS who presented with right lower quadrant abdominal pain, high fever, nausea and vomiting, but without leukocytosis. Diagnosis of CMV appendicitis was confirmed by appendectomy and histopathological examination. Problems related to the diagnosis and therapeutic management of CMV appendicitis in AIDS patients are discussed. The importance of early surgical intervention is emphasized, as is postoperative ganciclovir therapy for treatment of such patients.
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PMID:Cytomegalovirus appendicitis in a patient with acquired immunodeficiency syndrome: a case report. 931 28

It's well known that patients was acquired immunodeficiency syndrome (AIDS) can develop various kinds of hepatobiliopancreatic diseases, for causes related to AIDS and for causes not related to HIV infection. The authors describe a case to their attention due to a suspected acute pancreatitis. The patient presented with abdominal pain, increased serum alkaline phosphatase and amylase levels. Serological test and stool concentration didn't show any opportunistic infection (Cytomegalovirus, Cryptosporidium). Abdominal ultrasonography showed enlargement of the head of the pancreas, gallbladder with biliary sludge, and a little dilatation of the biliary tree. The patient didn't feel better despite the medical treatment, so considering the probability of the migration of calculus, the patient underwent cholecystectomy. After the operation the patient felt better quickly. This case confirms the presence in HIV patients of pancreatitis for causes unrelated to AIDS like cholelithiasis as we showed, alcoholism, hypercalcemia, and the importance of an opportune surgical treatment that was resolutive.
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PMID:[Acute pancreatitis and AIDS]. 932 71

Cytomegalovirus (CMV) infects a significant number of otherwise healthy individuals. Although most cases are subclinical and therefore not diagnosed, some patients present with a mononucleosis-type illness. Ganciclovir, an agent effective against CMV, has primarily been studied for use in immunocompromised patients. No formal studies have been done in immunocompetent individuals. We report a case of an otherwise healthy adult female with severe heterophile negative infectious mononucleosis. Her symptoms included high fever, malaise, myalgias, cough, and abdominal pain. Work-up revealed an acute CMV infection. Intravenous ganciclovir was given with dramatic clinical and laboratory improvement.
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PMID:Ganciclovir treatment of systemic cytomegalovirus in an immunocompetent host. 937 49

Cytomegalovirus infection is highly prevalent among heart transplant recipients. Symptomatic cytomegalovirus infection can occur in all parts of the gastrointestinal tract. Colonic lesions are usually manifest as hemorrhagic colitis. This is a case of cytomegalovirus colitis presenting as a colonic stricture mimicking a colonic carcinoma. The initial presentation was that of both cellular and humoral rejection with fever, abdominal pain, and microcytic anemia with heme-positive stools. An abdominal computed tomogram was pertinent for a suspicion of carcinoma in the midtransverse colon. After resolution of the rejection episode, colonoscopy was performed, the result of which was abnormal for a short, high-grade stricture in the midtransverse colon. The patient underwent a right hemicolectomy for the suspected tumor. The pathologic specimen showed cytomegalovirus inclusion bodies with acute suppurative ulceration. The early diagnosis and treatment of cytomegalovirus colitis may lead to avoidance of more serious complications such as stricture formation.
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PMID:Cytomegalovirus infection presenting as an apple-core lesion of the colon. 940 18

We describe the clinical and pathologic features of a hitherto unreported finding in patients with esophagitis: the presence of multinucleated squamous epithelial giant cells simulating viral cytopathic effect and/or dysplasia. Routinely processed hematoxylin and eosin (H&E)-stained slides of esophageal mucosal biopsies from 14 patients with both active esophagitis and multinucleated epithelial giant cells were evaluated for a variety of inflammatory and epithelial features. Clinical, endoscopic, and follow-up data were collected and correlated with the histologic findings. Immunostaining (ABC method) for cytokeratin AE1/AE3, S-100, MIB-1, herpes simplex virus 1 and 2 (HSV), cytomegalovirus (CMV), as well as DNA in situ hybridization for human papilloma virus (HPV-ISH) was performed in all cases. Electron microscopic evaluation for viral particles was performed in three cases. The study group consisted of nine men and five women (mean age 59 years; range 23-87 years; 12 white, one black, one Hispanic). Patients presented with dysphagia or odynophagia (n = 5), upper gastrointestinal bleeding (n = 5), heartburn (n = 2), or abdominal pain (n = 2). The etiology of esophagitis was attributed to gastroesophageal reflux in 10, radiotherapy in one, Candida infection in one, drug-induced (alendronate) in one, and unknown in 1. Endoscopically, seven patients had an ulcer or erosion, four erythema, two stricture formation, and one white mucosal plaques. Microscopically, all cases showed multiple multinucleated (mean three nuclei per cell, range two to nine) squamous epithelial cells (range 2 to 11 cells per biopsy) confined to the basal zone in nine of 14 cases and involving the basal and superficial epithelium in the remainder. The nuclei contained a single or multiple eosinophilic nucleoli with a perinucleolar halo, but no inclusions, hyperchromaticity, or atypical mitoses. All cases showed associated nonspecific features of active esophagitis such as ulceration, neutrophilic and eosinophilic inflammation, basal cell hyperplasia, and elongation of the lamina propria papillae. The multinucleated giant cells, in all cases, were strongly positive for cytokeratin AE1/AE3 and were negative for S-100, HSV I and II, CMV, and HPV-ISH. MIB-1 positivity was observed in all basally located multinucleated giant cells, whereas those in the more superficial layers were negative. Electron microscopy failed to show viral particles in three of three cases. After treatment, all patients demonstrated clinical improvement. Three patients in whom follow-up biopsies were performed showed no evidence of esophagitis, epithelial cell multinucleation, or dysplasia. Multinucleated epithelial giant cell changes may rarely be seen in patients with esophagitis of varying etiology and probably represent a regenerative response to injury. This feature is important to distinguish from either viral cytopathic effect or dysplasia.
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PMID:Multinucleated epithelial giant cell changes in esophagitis: a clinicopathologic study of 14 cases. 942 21

The histologic features of acute graft-versus-host disease (GVHD) of the colon are well documented, but chronic mucosal changes associated with GVHD are poorly described. We report here the clinicopathologic findings from five patients with a history of bone marrow transplantation in which colonoscopic biopsies showed chronic mucosal changes reminiscent of chronic idiopathic inflammatory bowel disease (IBD). The patients ranged in age from 2.5 to 31 years. Bone marrow transplantations were performed for leukemia (3 patients), Hodgkin's disease (1 patient), and metachromatic leukodystrophy (1 patient). Endoscopy was performed because of complaints of abdominal pain and diarrhea in all of the five patients. The mean time after transplantation in which histologic features of chronicity were identified was 5.8 months (range, 3-16 mo). All of the five patients had prior colonic biopsies showing acute GVHD. One patient had a previous episode of cytomegalovirus infection. Chronicity was characterized by mild-to-moderate architectural distortion, ie., villiform surface with crypt branching and atrophy, similar to that seen in chronic idiopathic IBD. The lamina propria was hypocellular, with prominent small blood vessels. Focal fibrosis of the lamina propria was noted. One patient had active cryptitis. Superimposed changes of acute GVHD were mild to absent. None of the patients had a history of IBD before receiving the bone marrow transplant. Changes associated with chronicity can be observed in mucosal biopsy specimens from patients with GVHD. It is uncertain whether these changes are directly caused by GVHD or are the result of superimposed infections. The association of chronic mucosal change in the setting of GVHD with the clinical diagnosis of chronic GVHD needs additional investigation.
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PMID:Chronic mucosal changes of the colon in graft-versus-host disease. 964 87

We present a rare case of adult T cell leukemia (ATL) in which leukemic T cells simultaneously expressed CD4 and CD8 surface antigens and refractory cytomegalovirus (CMV)-induced gastroenterocolitis preceded its clinical onset. A 40-year-old male was admitted to our hospital with abdominal pain and bloody stool. Biopsy specimens of the gastric and rectal mucosa indicated CMV-induced gastroenterocolitis. The patient also proved to be seropositive for human T lymphotropic virus type I (HTLV-I). While being administered gancyclovir for CMV infection, he presented hepatomegaly and systemic lymphadenopathy. Monoclonal expansion of lymphoid cells integrated with HTLV-I genome was observed. He underwent a LSG15 regimen and hepatomegaly and lymphadenopathy improved markedly. Gastroenterocolitis also improved, but the symptoms did not disappear completely. CMV-induced diseases are prevalent among immunosuppressed patients. Although there was no evidence that this patient had ATL on admission, it is likely that he was severely immunodeficient. CMV can easily infect damaged mucosa. ATL cells often infiltrate gastrointestinal mucosa and may have triggered CMV gastroenterocolitis in this case.
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PMID:CD4/CD8 double-positive adult T cell leukemia with preceding cytomegaloviral gastroenterocolitis. 1007 57

A 30-year-old nonimmunocompromised woman developed chronic gastrointestinal dysmotility as a consequence of acute cytomegalovirus infection. The acute nature of the infection was documented by high immunoglobulin M antibody titer to cytomegalovirus (CMV); the chronicity of the infection was shown by persistence of CMV in biopsy specimens of her gastrointestinal tract over a 21/2-year period. Gastrointestinal dysmotility was confirmed by delayed emptying on gastric nuclear scintigraphy, by retrograde propagation of migrating myoelectric complexes on small intestinal manometry, and by presence of tachygastria on cutaneous electrogastrography. The patient's nausea, vomiting, abdominal pain, and early satiety resolved after a short course of treatment with leuprolide acetate but returned after medication was discontinued. Her symptoms persisted despite clearance of CMV from the gastrointestinal tract after a course of treatment with ganciclovir. These observations show that acute CMV infection can cause gastrointestinal dysmotility in nonimmunocompromised individuals and that the disturbance in gastrointestinal motor function may persist for years after viral infection of the gastrointestinal tract has been eradicated.
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PMID:Evolution of acute cytomegalovirus gastritis to chronic gastrointestinal dysmotility in a nonimmunocompromised adult. 1009 18


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