Abstract
A 33-year-old man with a history of Hodgkin lymphoma was seen 92 days after allogenic stem cell transplantation; he presented with a 5-day history of large-volume watery diarrhea. The results of laboratory evaluation and stool studies were noncontributory. Flexible sigmoidoscopy with examination of biopsy specimens revealed mild chronic colitis with no evidence of graft-versus-host disease (GVHD). Nevertheless, the patient was given systemic and nonabsorbable steroid agents. However, he continued to have large-volume diarrhea, worsening anorexia, and malnutrition. Colonoscopy with ileal intubation was performed, and examination of biopsy specimens showed positivity for cytomegalovirus (CMV) colitis. Esophagogastroscopy revealed complete mucosal sloughing in the duodenum forming a tubular structure (A, B). The biopsy specimens were consistent with GVHD, histologic grade 3/4 with negative CMV stain. The patient received a therapeutic dose of gancyclovir and escalated doses of systemic steroid agents, cyclosporine, methotrexate, and folic acid. The patient’s overall clinical status improved gradually over a period of 3 weeks. A follow-up esophagogastroscopy after 1 month showed regenerative nodular mucosa (C).
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