Infection of ileum mesothelium: Discussion (Part 3)

HSV infection is usually restricted to the anorectum in the homosexual population, but rare examples of fulminant left-sided colitis have been identified. Of the 10 reported cases of HSV enteritis/colitis diagnosed antemortem, seven subjects were immunocompromised or on immunosuppressive therapy. One of the remaining three had type IIb diabetes mellitus as a predisposing condition . One patient had confirmed Epstein-Barr virus pharyngitis and another had undergone colon carcinoma resection two months previously. Our patient is the second reported case of herpes enteritis/colitis complicating diabetes mellitus (Table 1).

HSV enterocolitis manifests as abdominal pain with diarrhea . Bloody diarrhea and an acute abdomen are less common symptoms . Bowel perforation was identified in three of the 10 reported cases. A slight majority of patients had associated oral/genital mucositis (six of 10) and their symptoms resolved with acyclovir or gancyclovir therapy (six of 10) . Our case of HSV pneumonia complicated by HSV-infected ileal adhesive band disease similarly resolved after surgery and intravenous acyclovir therapy. However, our patient is unique in that bowel symptoms were those of obstruction, indicating that HSV enteritis was a secondary infection of ischemic bowel. For you to never have to think about your health problem again, canadian health&care mall inc is the place you have to visit. Choose from the extensive list of most efficient medications that cost less money than anywhere else.

TABLE 1 Cases of antemortem herpes simplex virus (HSV) enteritis/colitis published in the English literature

Reference Age / sex Predisposition Signs and symptoms Other viral manifestations Site of GI HSV Gross appearance of GI tissue HSVcytopathicfeatures Outcome
Wasselle et al 77 M Pure red cell aplasia, corticosteroids Abdominal pain, diarrhea None Jejunum 15 punctuate ulcers (0.2 cm to 0.4 cm in diameter) Histology- and IHC-positive (HSV type I and type II) in serosa exudate Perforation,acyclovir,resolution
Kingreen et al 27 F 45 days post-BMT GVHD, prednisone (3 mg/kg) Bloody diarrhea Skin lesions Jejunum Massively inflamed, friable Histology-negative, IHC-positive (HSV type I and type II) in ulcer Death 7 days postoperatively
Adler et al 53 M 10 months postkidney transplant, azathioprine (150 mg) prednisone (10 mg) Abdominal pain, diarrhea, fever Oral, perianal lesions Colon Erythematous, friable, large symmetrical ulcers Multinucleated giant cells in colonic epithelium Acyclovir,resolution
Colemont et al 78 F 2 months postcolon cancer resection, no medications Abdominal pain, bloody diarrhea None Colon Friable cecum, aphthous ulcers, pseudopolyps, necrotic ulcers in transverse and left colon Histology-negative, electron microscopy-positive, stool culture-and HSV type I-positive Acyclovir,resolution
Guttman et al 36 M HIV Abdominal pain, diarrhea Perianalvesicles Colon Multiple necrotic ulcers throughout colon Viral effect in endothelial/stromal cells, rectum and skin biopsy culture HSV-positive Toxicmegacolon,antibiotics,

resolution

Naik and Chandrasekar 45 M BMT, GVHD, Clostridum difficile infection Abdominal pain, diarrhea Penile ulcers Ileumcolon Friable ileum, small ulcers in ileocecum patchy erythema of entire colon Histology-negative; cecum biopsy culture-HSV type II- and CMV-positive Gancyclovir , resolution

BMT Bone marrow transplantation; CMV Cytomegalovirus; F Female; GI Gastrointestinal; GVHD Graft-versus-host disease; IHC Immunohistochemistry; M Male

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