Nutritional support in a patient with Cytomegalovirus (CMV) enterocolitis in the acquired immunodeficiency syndrome (AIDS)

Abstract

Introduction: Several diseases of the gastrointestinal tract should be taken into account in patients with the human immunodeficiency virus (HIV) since diarrhea negatively affects the patient's quality of life. Given this condition, Cytomegalovirus (CMV) enterocolitis may present with fever, weight loss, intermittent diarrhea, and hematochezia. Objective: This study aimed to report the effect of enteral supplementation with L-glutamine and oligomeric enteral nutritional therapy (ENT) formula in patients with cytomegalovirus, and with refractory diarrhea associated with wasting HIV syndrome. Methods: The information contained in this report was obtained through a review of the medical record and a review of the literature. Results: This is the report of S. S. A, a female, 27 years old, who was admitted to Hospital Ernesto Dornelles, in Porto Alegre, from 11/15/2020 to 12/30/2020, diagnosed with HIV for a month, without undergoing treatment. The patient was hospitalized due to worsening abdominal pain starting 2 days ago, with diarrhea and mental confusion. On physical examination, she presented pain in the lower abdominal region. From anthropometry, the measured weight of 67kg, the self-reported height of 1.67m, and BMI of 24kg/m2. On 11/17, she presented PCR-CMV positive for CMV and underwent laparotomy for pneumoperitoneum with endarterectomy due to perforation of the distal ileum. In use of ganciclovir for CMV. On December 2, the upper digestive endoscopy with biopsy showed an esophagus with the Z-line located close to the diaphragmatic clamping, with esophageal mucosa with extensive, friable, serpiginous ulcers, being a valuable diagnosis in CMV enterocolitis. From 12/04 to 12/08, she used exclusive enteral L-glutamine 20g/day. On 12/09, she started an oligomeric formula via the low-flow enteral route with progression to the caloric and protein targets. On 12/30, the patient had improved diarrhea, with a depressible and painless abdomen, and had been discharged. Final Considerations: In the present report, it was obtained a beneficial effect with the nutritional intervention using L-glutamine and enteral oligomeric formula in the treatment of diarrhea. Thus, the improvement in the condition in just 5 days can be explained by the rhythm of the enterocyte cell cycle, which occurs in an average period of 3 days, and it is possible that the 4 day period of nutritional intervention is sufficient to increase endogenous levels of L-glutamine.