P0530 DIFFERENT CLINICAL PATTERNS OF GASTROINTESTINAL CYTOMEGALOVIRUS INFECTION IN IMMUNOCOMPETENT CHILDREN: REPORT OF FOUR CASES

Abstract

Introduction: Gastrointestinal manifestations of Cytomegalovirus (CMV) infection have been frequently observed in mmunocompromised subjects, while are rare in immunocompetent individuals and particularly in children. Methods: We report four cases of immunocompetent paediatric patients affected by different gastrointestinal diseases caused by CMV infection observed during the last two years and whose medical records were reviewed with regard to clinical and laboratory data and outcome. Results: We observed 4 patients: 2 with severe protracted diarrhoea, 1 with severe hemorrhagic colitis and 1 with gastro-esophageal reflux. They shared uneventfully birth, unrelative parents, beginning of symptoms in the first months of life, no underlying disease, no bacterial pathogens nor Giardia antigen isolation, histologic evaluation of duodenal mucosa with no macroscopic lesions, positive CMV-polimerase chain reaction (PCR) in urine, stool, gastric aspirate and intestinal mucosa. Specific inclusions were seen only in duodenal mucosa of patient 2. All patients needed for prolonged artificial nutrition and showed food allergy and a recurrence of infections during their hospital stay. Case 1. S.A. Male, born in March 2002 presenting a protracted diarrhea. The diagnosis was made only after 3 months of PN and because of his improved condition and parents refusal he was not treated with antiviral agent. Case 2. V.P. Male, born in December 2002, presenting with a protein-loosing protracted diarrhea. In this case too we failed to demonstrate the presence of CMV-IgM but he had high CMV-IgG and received an intravenous therapy with ganciclovir. Now he is still on HPN after nine months, now associated with a partial oral alimentation, and he is still treated with ganciclovir by mouth. Case 3. F.E. Female, born in June 2002, showing a severe hemorrhagic colitis and needed total PN for 13 months and ganciclovir several treatments first given intravenously and then by mouth. Case 4. F.A. Male, born in April 2003, at two months of age he began to present vomiting, food refusal and recurrent upper respiratory tract infections. He was started on enteral nutrition. He had a positive CMV-PCR in gastric aspirate, urine, and gastric mucosa. He was treated with ganciclovir by month. Conclusion: Our experience seems to demonstrate that CMV gastrointestinal infection with severe symptoms is less rare than we are used to think also in children. It could be more frequent as vertical infection in gastroesophageal reflux and as primary infection in enterocolitis and that pharmacological treatment may not be indispensable.