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Cytomegalovirus-associated pseudotumor mimicking ceccum carcinoma in a non inmunocompromised patient
Pseudotumor asociado a citomegalovirus simulando un carcinoma de ciego en un paciente inmunocompetente
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"cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Cytomegalovirus-associated pseudotumor mimicking ceccum carcinoma in a non inmunocompromised patient" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "515" "paginaFinal" => "516" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Diego Casas Deza, Elena Betoré Glaria, Olivia Sierra Gabarda, Lara Luzón Solanas, Marta Gascón Ruiz, Eva Sierra Moros" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Diego" "apellidos" => "Casas Deza" "email" => array:1 [ 0 => "diegocasas8@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Elena" "apellidos" => "Betoré Glaria" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Olivia" "apellidos" => "Sierra Gabarda" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Lara" "apellidos" => "Luzón Solanas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "Marta" "apellidos" => "Gascón Ruiz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Eva" "apellidos" => "Sierra Moros" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Oncología Médica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Pseudotumor asociado a citomegalovirus simulando un carcinoma de ciego en un paciente inmunocompetente" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1379 "Ancho" => 1800 "Tamanyo" => 218837 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image A shows the pseudotumour in the first colonoscopy. Images B and C show the lesion in the second colonoscopy. Image D shows mucosal healing after antiviral treatment.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present the case of a 64-year-old man, with no medical or surgical history of note, who visited the accident and emergency (A&E) department for nonspecific abdominal pain associated with weight loss of 9 kg. He had no diarrhoea, fever, nausea or vomiting. He had no notable family history, had not taken any drugs in the previous few months and had no unhealthy habits. Blood testing showed no significant abnormalities, but due to his weight loss, it was decided to admit the patient from the A&E department for investigation.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A computed tomography scan of the abdomen revealed asymmetric thickening in the caecum, whereupon a colonoscopy was ordered. It showed an ulcerated tumour occupying the entire caecum, with no abnormalities in the rest of the mucosa (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, Image A). The biopsies were inconclusive as regards malignancy. A second colonoscopy was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, Images B and <span class="elsevierStyleSmallCaps">C</span>), in which new samples were taken. This time, the immunohistochemical study showed the biopsies to be positive for cytomegalovirus, but not for dysplasia or carcinoma. Serology was positive for cytomegalovirus IgG.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was treated with a 21-day course of oral valganciclovir, 900 mg every 24 h. A repeat colonoscopy two weeks after completion of treatment to assess endoscopic response and ensure healing revealed that the pseudotumour had completely disappeared (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>, Image D). The patient is currently asymptomatic.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was investigated for possible immunosuppressive factors, but no disease or condition suggestive of a state of immunosuppression were found.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cytomegalovirus infection can affect any part of the gastrointestinal tract. It is much more likely in patients with HIV, history of transplantation, use of corticosteroids, inflammatory bowel disease or chemotherapy treatment. Among immunocompetent patients, use of corticosteroids and transfusion of blood derivatives have been identified as risk factors for cytomegalovirus colitis.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its incidence also increases with age, due to a reduced capacity for action on the part of T cells.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The usual symptoms are abdominal pain and diarrhoea, and up to half of patients may develop rectal bleeding or haematochezia. Endoscopic findings are non-specific.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> A diagnosis should be based on observation of inclusion bodies in non-neoplastic mucosa cells with haematoxylin and eosin staining, and supported by immunohistochemical techniques using monoclonal antibodies. Approximately two-thirds of patients have positive serology.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The most common endoscopic presentation consists of well-defined ulcers and pseudomembranes, but in rare cases, it can appear as a newly formed mass,<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a> in which case, colon cancer must be ruled out.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The treatment of cytomegalovirus colitis is not well established in current guidelines, particularly in immunocompetent patients with no comorbidities, such as our patient.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Given his good general condition, he was prescribed oral treatment and therefore could be followed up on an outpatient basis with no need to admit him.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Casas Deza D, Betoré Glaria E, Sierra Gabarda O, Luzón Solanas L, Gascón Ruiz M, Sierra Moros E. Pseudotumor asociado a citomegalovirus simulando un carcinoma de ciego en un paciente inmunocompetente. Gastroenterol Hepatol. 2020. <span class="elsevierStyleInterRef" id="intr0005" href="https://doi.org/10.1016/j.gastrohep.2020.02.015">https://doi.org/10.1016/j.gastrohep.2020.02.015</span></p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1379 "Ancho" => 1800 "Tamanyo" => 218837 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Image A shows the pseudotumour in the first colonoscopy. Images B and C show the lesion in the second colonoscopy. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 2 | 0 | 2 |
| 2024 October | 15 | 4 | 19 |
| 2024 September | 28 | 3 | 31 |
| 2024 August | 16 | 8 | 24 |
| 2024 July | 28 | 5 | 33 |
| 2024 June | 16 | 2 | 18 |
| 2024 May | 10 | 3 | 13 |
| 2024 April | 19 | 15 | 34 |
| 2024 March | 31 | 2 | 33 |
| 2024 February | 23 | 2 | 25 |
| 2024 January | 16 | 5 | 21 |
| 2023 December | 28 | 4 | 32 |
| 2023 November | 16 | 3 | 19 |
| 2023 October | 20 | 2 | 22 |
| 2023 September | 15 | 2 | 17 |
| 2023 August | 24 | 1 | 25 |
| 2023 July | 41 | 4 | 45 |
| 2023 June | 35 | 2 | 37 |
| 2023 May | 79 | 5 | 84 |
| 2023 April | 45 | 4 | 49 |
| 2023 March | 59 | 0 | 59 |
| 2023 February | 51 | 1 | 52 |
| 2023 January | 27 | 4 | 31 |
| 2022 December | 33 | 9 | 42 |
| 2022 November | 40 | 8 | 48 |
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