An Unexpected Cause of Acute Abdomen Late After Heart Transplantation-A Case Report

Autores da FMUP

• Sandra Maria Resende Amorim

  Autor

• Maria De Lurdes Campos Dos Santos

  Autor

• Luís Filipe Vilela Pereira De Macedo

  Autor

Participantes de fora da FMUP

• Araújo, P
• Pinto, R
• Medas, R
• Pereira, P
• Lopes, J
• Pinheiro-Torres, J
• Pinho, P

Unidades de investigação

• Medicina

Abstract

Cytomegalovirus (CMV) infection is a frequent complication after a solid organ transplant, and in 86% of the cases, CMV disease occurred during the first 6 months after transplantation. Invasive CMV infections may be present as ulcerative infections of the upper gastrointestinal tract with esophagitis, gastritis, and ulcerations of the duodenum and the small bowel; however, CMV infections of the pancreatobiliary system, especially papillitis, are rarely observed. We present a case report of a man who underwent a heart transplant 6 years before, with a clinical picture of duodenitis and a simultaneous pseudotumor of major duodenal papilla who developed signs of acute abdomen caused by gastrointestinal CMV infection, successfully treated with medical therapy with valganciclovir. There is an urgent need for developments in CMV and solid organ trans-plantation to stratify the risk of late-onset CMV disease.

Keywords

• Abdomen, Acute; Ampulla of Vater; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Gastrointestinal Diseases; Heart Transplantation; Humans; Male; Valganciclovir; acetylsalicylic acid; cotrimoxazole; creatinine; cyclosporine; mycophenolate mofetil; prednisolone; rosuvastatin; valganciclovir; antivirus agent; ganciclovir; valganciclovir; abdominal pain; acute abdomen; adult; anorexia; Article; ascites; asthenia; cancer hormone therapy; case report; chronic kidney failure; clinical article; computer assisted tomography; creatinine blood level; cytomegalovirus infection; duodenitis; duodenoscopy; duodenum ulcer; gastrointestinal endoscopy; gastrointestinal infection; heart transplantation; hemodialysis; human; human tissue; intestine biopsy; ischemic cardiomyopathy; kidney injury; laparoscopy; laparotomy; leukocytosis; leukopenia; male; middle aged; neutropenia; normochromic normocytic anemia; patient history of heart transplantation; prostate cancer; pseudotumor; risk assessmen