Abstract
BackgroundChronic diarrhea in patients treated with immunosuppressive agents or suffering from immunosuppressive disease can represent a diagnostic and therapeutic challenge to the clinician. Norovirus infection, a major cause of acute epidemic diarrhea, has been described as a cause of chronic diarrhea in patients who are immunosuppressed, including transplant recipients and the very young.Case presentationsWe describe two patients, a 64 year-old man and a 59 year-old woman, both suffering from chronic lymphocytic leukemia and hypogammaglobulinemia, who developed chronic diarrhea resistant to therapy. In both cases, after months of symptoms, persistent norovirus infection--documented by repeatedly-positive high-sensitivity stool enzyme immunoassay--was found to be the cause. Both patients died with active diarrheal symptoms.ConclusionsWe describe the first cases of advanced chronic lymphocytic leukemia to suffer from chronic symptomatic norovirus infection. Clinicians caring for such patients, particularly those with concomitant hypogammaglobulinema, who have chronic unexplained diarrhea, should consider norovirus infection in the differential diagnosis.
Highlights
Chronic diarrhea in patients treated with immunosuppressive agents or suffering from immunosuppressive disease can represent a diagnostic and therapeutic challenge to the clinician
We describe the first cases of advanced chronic lymphocytic leukemia to suffer from chronic symptomatic norovirus infection
Clinicians caring for such patients, those with concomitant hypogammaglobulinema, who have chronic unexplained diarrhea, should consider norovirus infection in the differential diagnosis
Summary
While CLL associated with hypogammaglobulinemia is commonly linked to recurring infection, [5] our literature search failed to find other reports of patients with CLL suffering from persistent diarrhea as a result of chronic norovirus infection. GMJ, RS and WCM participated in reviewing the cases, drafting and editing the manuscript, and obtaining consent for publication. Wingfield T, Gallimore CI, Xerry J, Gray JJ, Klapper P, Guiver M, Blanchard TJ: Chronic norovirus infection in an HIV-positive patient with persistent diarrhea: a novel cause. Beatty GW: Diarrhea in patients infected with HIV presenting to the Emergency Department. Pre-publication history The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2334/11/131/prepub doi:10.1186/1471-2334-11-131 Cite this article as: Capizzi et al.: Chronic diarrhea associated with persistent norovirus excretion in patients with chronic lymphocytic leukemia: report of two cases.
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