Disseminated Cytomegalovirus Infection Research Articles

Death from human cytomegalovirus infection in a girl with congenital thymic dysplasia

We report the case of a girl with congenital thymic dysplasia and refractory disseminated Human Cytomegalovirus (CMV) infection diagnosed by autopsy. Additionally, she was diagnosed with T-cell lymphopenia immunodeficiency and received antiviral therapy with ganciclovir (GCV) /valganciclovir (V-GCV) and enhanced foscarnet. The CMV viral load (VL) monitoring was elevated with retinitis, interstitial pneumonia, and hepatitis. The phenotype of T-cell lymphopenia was uncertain, which limited any alternative therapy by whole-exome sequencing (WES) and lymphocyte subset panel until autopsy. The girl died of progressive respiratory failure and septic shock at ten months of age. Severe disseminated CMV infection typically develops in infants with primary maternal infections and occurs earlier during gestation and in people with a weakened host immune system. Individuals with CMV infection with initial immunodeficiency are associated with a poor prognosis, which is similar to patients with secondary immunodeficiency. This case describes the difficult treatment and prognosis of CMV infection in patients with congenital immunodeficiency, highlighting the importance of early aggressive anti-CMV antiviral therapy in immunodeficiencies, VL monitoring, drug resistance and the role of T-cells in CMV infection.

Disseminated Cytomegalovirus Infection in a Patient with RAG2 Mutation SCID Transmitted via Breast Feeding: A Case Report and Review of Literature

Disseminated Cytomegalovirus Infection in a Patient with RAG2 Mutation SCID Transmitted via Breast Feeding: A Case Report and Review of Literature

Survival Outcomes Following Allogeneic Stem Cell Transplantation for Inherited Bone Marrow Failure and Myeloid Germline Predisposition Syndromes

Introduction: Allogeneic stem cell transplant (HCT) is the only potential curative option for patients with inherited marrow failure (iBMF) and myeloid germline predisposition syndromes (GPD). HCT outcomes are influenced by inherent disease specific-nuances such as alkylating agent and radio-sensitivity, immune deregulation, and higher risks for graft failure and GVHD; factors contributing to transplant related mortality (TRM) and morbidity. We carried out this retrospective study to assess survival outcomes and long term complications (LTC) in patients with IBMF and GPD that underwent HCT. Patients and methods: We queried our institutional database and identified patients with iBMF and GPD as defined by the 2016 WHO classification. These included Fanconi anemia (FA), short telomere syndromes (STS), Diamond-Blackfan anemia (DBA), GATA2 and RUNX1 haploinsufficiency, congenital amegakaryocytic thrombocytopenia (CAMT), deficiency of adenosine deaminase 2 (DADA2), among others. Patients with acquired causes of BMF were excluded. Statistical analyses were performed using SAS (JMP v14.1). Results: Twenty eight patients, median age 10 years (1 month-63 years), 46% males, were included in the study (table 1). Fanconi anemia Seven (25%) patients with FA underwent HCT, 5 (71%) without myeloid transformation and 2 after transformation to MDS/AML. Five (71%) patients received a RIC, 4 (57%) prior to transformation. At a median follow up (FU) of 126 m, the median OS was 194 m (95% CI 34m; NR) and 10 year survival was 64%. Grade 1 aGVHD was seen in four (57%) and 3 (42%) developed mild cGVHD, while 1 developed a donor derived AML (sibling not tested for FA). LTC included second primary malignancy (SPM) - squamous cell cancer (SCC) of skin and muscle invasive bladder cancer (MIBC) in 1(14%) and SCC of head/neck and anogenital region in 3 patients (43%), psychosocial complications (PS) in 6(85%), premature ovarian failure (POF) in 3(43%), and avascular necrosis (AVN) in 4(57%) patients. Short Telomere Syndromes (STS) Seven patients with STS underwent HCT, 2 (28%) after transformation to MDS. Five (71%) received RIC, including both the transformed patients. At a median FU of 67m, median OS was NR (95% CI 2m; NR) and 5 year survival was 47%. One (14%) patient developed grade 2 aGVHD and mild cGVHD of skin. Three (43%) developed SPM - skin cancers in 2 and MIBC in 1. PS was noted in 1(15%), and AVN in 3(43%). Three (43%) patients had concomitant mild IPF/restrictive lung disease. GATA2 haploinsufficiency : Seven patients with GATA2 haploinsufficiency underwent HCT; 2(28.5%) after transformation to MDS and 3(43%) to AML, of which 2(40%) received MAC. At a median FU of 57m, median OS was NR (95% CI 7m; NR) and 5 year survival was 71%. Three (50%) developed grade 2 aGVHD of skin and GI tract and 2(33%) developed mild cGVHD. LTC include PTLD, AVN and POF in 1 patient each. Ribosomopathies : One patient (13y) with DBA underwent RIC HCT and developed grade 2 aGVHD, secondary iron overload, and died at 10 months due to severe fungal infection. Others : Identical twins with CAMT underwent HCT (at 4y and 5y) from the same unrelated donor and at last FU (74m and 87m, respectively) remain 100% donor without GVHD. Two children with primary immunodeficiency and marrow failure underwent HCT (at 2y and 7y), one after transformation to MDS. The non-transformed patient is currently alive (120m), while the patient with transformation died 1month after HCT from disseminated cytomegalovirus infection. One patient with germline RUNX1 deletion developed CMML and underwent a RIC HCT and is alive at a FU of 4 months, with no GVHD. One patient with DADA2 (n=1) underwent RIC HCT without LTC. Due to the smaller cohort size, we compared OS in transformed and non-transformed patients for the IBMF and GATA2 patients only (n=24, 9 with transformation) (figure1). At a median FU of 74m, the median OS of transformed vs non-transformed patients was 108m(95% CI 1;108m) and 163m(95% CI 67m; NR), respectively (p=0.033). Conclusions: Our study demonstrates that HCT remains an important intervention for IBMF and GPD, with the maximum impact being gained prior to transformation. While only mild chronic GVHD was noted (37%), inherent syndromic issues resulted in a high rate of SPM (FA/STS) and organ failure (STS- IPF). Notably, one FA patient who received an MRD HCT developed donor derived AML, underlining the importance of genetic screening in asymptomatic related individuals. Disclosures Kenderian: Lentigen: Research Funding; Kite/Gilead: Research Funding; Morphosys: Research Funding; Humanigen: Other: Scientific advisory board , Patents & Royalties, Research Funding; Novartis: Patents & Royalties, Research Funding; Tolero: Research Funding. Patnaik:Stem Line Pharmaceuticals.: Membership on an entity's Board of Directors or advisory committees.

An Infant with Respiratory Distress and Loose Stools

We present the case of a 3-month-old girl who was admitted with complaints of loose stools and respiratory distress. She also had a history of rash and alopecia. Laboratory investigations revealed lymphopenia with reduced immunoglobulin G and immunoglobulin A. Lymphocyte subset analysis by flow cytometry revealed T-B+NK+ severe combined immunodeficiency (SCID). She died due to severe pneumonia, shock and pulmonary hemorrhage. Autopsy findings revealed disseminated cytomegalovirus infection in the lung, liver, adrenals and heart. Thymus was found to be dysplastic and showed characteristic histopathologic features of SCID.

Severe combined immunodeficiency presented with disseminated cytomegalovirus infection: a case report

Severe combined immunodeficiency presented with disseminated cytomegalovirus infection: a case report

Fatal disseminated cytomegalovirus infection with necrotizing oophoritis in a patient with acquired immunodeficiency syndrome

Disseminated human cytomegalovirus (CMV) disease occurs mainly as a congenital infection and among immunocompromised hosts. Patients with acquired immunodeficiency syndrome (AIDS) are at increased risk for CMV infection, and the most prevalent clinical manifestation is retinitis, followed by colitis, esophagitis, pneumonitis, and encephalitis. CMV oophoritis is poorly described in the literature with some cases reported in patients with hematological or solid malignancies, bone marrow or solid organ transplantation, immunosuppressive therapy, and advanced AIDS cases. We report the case of a 61-year-old woman with a recent diagnosis of AIDS, which was associated with a wasting syndrome. The patient presented with abdominal pain, headache, cutaneous vesicular lesions on the abdomen, anemia, lymphopenia, and hyponatremia; she died suddenly on the fourth day of hospitalization. The autopsy was performed and demonstrated disseminated CMV infection with hemorrhagic encephalitis as the immediate cause of death. Additionally, pneumonitis, extensive adrenalitis, ulcerated enteritis, focal hepatitis, and necrotizing oophoritis were found.

A Case Treated with Extracorporeal Membrane Oxygenation for Disseminated Cytomegalovirus Infection after Liver Transplantation

A Case Treated with Extracorporeal Membrane Oxygenation for Disseminated Cytomegalovirus Infection after Liver Transplantation

Cytomegalovirus Disease of the Upper Gastrointestinal Tract: A 10-Year Retrospective Study

Background and Aims: Cytomegalovirus (CMV) disease of the gastrointestinal (GI) tract is a major cause of morbidity and mortality in immunocompromised patients. The colon is the most commonly affected site, and the literature is scarce regarding CMV disease of the upper GI tract. Therefore, our study aimed to evaluate the clinical and endoscopic features of upper GI CMV disease. Methods: This 10-year retrospective study included all patients with a histopathological diagnosis of upper GI CMV infection. Patients' clinical, endoscopic, therapy, and follow-up data were collected from medical records. Results: Twelve patients with histopathologically proven upper GI CMV disease were identified (age 61 ± 18 years, 50% men). Most of the patients were immunocompromised (75%) due to acquired immunodeficiency syndrome (AIDS), malignancy, and/or immunosuppressive therapy. In the remainder (25%), the disease occurred in the absence of immunodeficiency and immunosuppression. Three patients (all with AIDS) presented with disseminated CMV infection. In the majority of the cases (83%), upper GI CMV disease was symptomatic, and the most common clinical presentations were odynophagia/dysphagia (25%) and nausea/vomiting (25%). Endoscopically, there were 5 cases of esophagitis (42%) and 7 cases of gastritis (58%). The lower esophagus (33%) and the gastric antrum (42%) were the most frequently affected GI sites. Regardless of the location, mucosal ulceration was the most common endoscopic finding (75%) and was associated with very deep ulceration resembling cavitation in 2 cases. Other endoscopic features were mucosal edema, hyperemia, and nodularity (25%). Eleven patients (92%) received antiviral treatment (duration 26 ± 12 days). The 1-month and 1-year mortality rates were 16.7 and 25%, respectively. Conclusions: Upper GI CMV disease can occur in the absence of immunodeficiency and immunosuppression. It is usually symptomatic, and mucosal ulceration is often evident at endoscopy. It is associated with significant mortality; therefore, early diagnosis and adequate antiviral treatment are essential.

Postmortem diagnosis of cytomegalovirus and accompanying other infection agents by real-time PCR in cases of sudden unexpected death in infancy (SUDI)

As an opportunistic pathogen with high mortality rates, Cytomegalovirus (CMV) may lead to fatal disseminated CMV infection of the premature and newborn; thus necessitating the demonstration of CMV-DNA with clinical history and/or histopathological findings of CMV infection and defining other bacterial and viral infection agents with real-time polymerase chain reaction (RT-PCR) in udden unexpected death in infancy (SUDI) cases as we aimed in this study.314 (144 female, 170 male) SUDI cases were prospectively investigated from January 2013 to January 2015 in Istanbul Forensic Medicine Institution. The study includes 87 tissue samples of 39 cases for post-mortem histopathological examination of interstitial pneumonia, myocarditis, meningitis, encephalitis, hepatitis, colitis or tubulointerstitial nephritis and/or accompanying chronic sialadenitis.CMV-DNA was found positive in 35 (40.2%) salivary gland, 19 (21.8%) lung, 1 (1.1%) tonsil, and 1 (1.1%) brain tissues. CMV sialadenitis and/or CMV pneumonia associated with other viral and/or bacterial agents were detected in 23 (60%) of 39 infant cases.The demonstration of CMV-DNA would significantly clarify the cause of death and collection of epidemiological data in SUDI cases with clinical history and histopathological findings of CMV infection accompanying chronic CMV sialadenitis. Furthermore, CMV suppresses the immune system, and may predispose to other bacterial and/or viral infections in these cases. Post-mortem molecular investigations are useful in explaining cause of death in SUDI with a suspicion of infection in forensic autopsies.

Cytomegalovirus (CMV) Adrenalitis Leading to Adrenal Insufficiency in a Patient with AIDS, Disguised by Concomitant Corticosteroid Administration: A Case Report

Background: Recognition of Cytomegalovirus related primary adrenal insufficiency in patients with Acquired Immunodeficiency Syndrome (AIDS) requires a high clinical suspicion in patients already on glucocorticoids, especially if the glucocorticoids are to be withdrawn. Case Presentation: We report the case of a 67 year old man with a new diagnosis of Human immunodeficiency virus and multiple AIDS defining illnesses including disseminated Cytomegalovirus infection. The use of six weeks of prednisone therapy for an exacerbation of chronic obstructive pulmonary disease resulted in a delay in the diagnosis of primary adrenal insufficiency from Cytomegalovirus in this patient resulting in marked hypoadrenal symptoms when prednisone therapy was stopped. Conclusion: Our case highlights the importance of investigating for adrenal insufficiency in patients with Cytomegalovirus adrenalitis, regardless of prior or concurrent treatment with glucocorticoids, particularly if glucocorticoids are to be withdrawn.

Disseminated Cytomegalovirus Infection in a Patient With Crohnʼs Disease on Adalimumab Therapy

Disseminated Cytomegalovirus Infection in a Patient With Crohnʼs Disease on Adalimumab Therapy

Cytomegalovirus Retinitis with Multiple Co Infections in a HIV/AIDS Patient having Extreme Low CD4 Count: A Case Report and Review of Literature

Introduction: HIV infection leads to a decrease in the CD4 count ultimately leading to the development of AIDS. Under this condition, within the body of the host several OIs manifest their pathological effects. With progressive decrease in CD4 count and with HIV disease progression, the pathogenic effects of these OIs increase several folds. Under this condition, dissemination of multiple infections is extremely common. Report of case: A 28 year old male patient presented with complaints of weakness, fever, weight loss, dry cough, respiratory distress and dimness of vision. He was HIV sero positive with CD4 count of 0.1 cells/μl of blood. Indirect opthalmoscopic investigations revealed Cytomegalovirus (CMV) retinitis. Treatment with wide spectrum antibiotics could not improve his respiratory distress. Broncoscopy or lung biopsy could not be performed due to his poor general condition. CMV PCR revealed high titre (5.1×107 copies of DNA/ml serum). In anticipation that his respiratory distress might be caused due to infiltration of CMV into the lungs and also to combat retinitis, i.e. Ganciclovir was started. On treatment, patient became afebrile and there was significant radiological improvement of pneuomonitis. He later developed urinary tract infection of Pseudomonas aeruginosa and was treated with Cotrimoxazole (800 mg). With HAART, CD4 increased to 66. Patient’s visual acuity improved slightly in left eye. Discussion: Early detection and prompt treatment of HIV and associated OIs is of utmost importance. The symptoms of Cytomegalovirus Retinitis are subtle and nonspecific. So, the clinician must have a high index of suspicion for diagnosing CMV retinitis. At extremely low CD4 counts, a disseminated cytomegalovirus infection should always be considered as a likely etiology of Pneumonitis. A CD4 Count of 0.1 cells/μl has made the case more novel. The initiation of HAART at extremely low CD4 counts may boost the immune system with rapid increase in CD4 coun

Cytomegalovirus infection of the major duodenal papilla in a renal allograft recipient with severe biliary obstruction and acalculous cholecystitis

Cytomegalovirus (CMV) can cause severe infections with serious consequences in renal transplant recipients. Disseminated CMV infections can affect almost every organ, but obstructive cholestasis and cholangitis, as a consequence of a CMV-induced papillitis, is extremely rare. We are reporting a rare case of obstructive cholestasis and cholecystitis due to CMV-related inflammation of the major duodenal papilla in a 60-year-old woman 3 months after renal transplantation. In addition, the patient suffered from a disseminated CMV infection with ulcerative esophagitis and gastritis. Because of the severe CMV infection, failure of the renal graft occurred. Obstructive cholestasis was resolved through internal stenting, and the progressive cholecystitis necessitated an emergency cholecystectomy. Following antiviral therapy with ganciclovir, the gastrointestinal ulcerations regressed and renal function was restored. Diagnosis of the CMV-related disease was established only in tissue samples, whereas standard serologic tests had failed.

Intravenous immunoglobulin replacement therapy to prevent pulmonary infection in a patient with Good's syndrome

Good's syndrome is an acquired immunodeficiency state associated with thymoma and characterized by recurrent pulmonary infections. We describe a 67-year-old woman who presented with respiratory symptoms caused by concomitant disseminated cytomegalovirus infection and Pneumocystis jiroveci pneumonia 38 months after thymectomy for a thymoma. Immunologic analysis revealed hypogammaglobulinemia with absent B-cell population as demonstrated by flow cytometry, consistent with Good's syndrome. Following treatment with sulfamethoxazole/trimethoprim and ganciclovir, the patient improved with resolution of her respiratory symptoms. However, the patient subsequently experienced additional infections, necessitating additional subsequent hospital admissions. During the last admission, intravenous immunoglobulin (IVIG) replacement therapy was initiated and continued after discharge. Infection has been prevented for one year after beginning IVIG replacement therapy. This case reveals that in patients with combined humoral and cell-mediated immune deficiency, concomitant infection with different pathogens is not unusual, and immediate specific therapy is important. Periodic IVIG infusion, to maintain adequate Ig levels, is recommended.

Prolonged Recovery from Pediatric Cardiac Surgery Due to Disseminated Cytomegalovirus Infection

Partial atrioventricular septal defect is usually followed by an uncomplicated postoperative course. We present an infant with unexplained persistent respiratory failure following partial a trioventricular septal defect repair. Extensive evaluation including bronchoalveolar lavage subsequently led to the diagnosis of disseminated cytomegalovirus. This is the first reported case to our knowledge of disseminated cytomegalovirus following surgical repair of congenital heart disease excluding orthotopic heart transplant.

Cytomegalovirus viraemia in the modern antiretroviral era*

Cytomegalovirus viraemia in the modern antiretroviral era*

Drug-specific risk of non-tuberculosis opportunistic infections in patients receiving anti-TNF therapy reported to the 3-year prospective French RATIO registry

BackgroundAnti-tumour necrosis factor (TNF) therapy may be associated with opportunistic infections (OIs).ObjectiveTo describe the spectrum of non-tuberculosis OIs associated with anti-TNF therapy and identify their risk factors.MethodsA 3-year national French...

Prior Mycobacterium avium complex infection is linked to immunological nonresponsiveness in HIV‐infected patients on highly active antiretroviral therapy

Department of Internal Medicine, School of Medicine, Faculty of Health Sciences,University of Botswana, Gaborone, BotswanaHighly active antiretroviral therapy (HAART) leads toimmune reconstitution, as demonstrated by a substantialincrease in CD4 T-lymphocyte count, which can happeneven in patients with advanced HIV disease and severeimmunodepression [1].However, up to 40% of HIV-infected patients are‘immunological nonresponders’; that is, they have dis-cordant responses to long-term HAART characterized bycomplete suppression of HIVreplication in the absence of asignificant increase in CD4 T-cell count [2,3]. An increasein CD4 T-cell count of o30% and an absolute CD4 count ofo200cells/mL during the first 6–12 months of HAARTidentify such nonresponders [3], who are at increased riskof HIV-related morbidity and mortality [4], and whoserelative risk of clinical progression to AIDS is approxi-mately double that of responders [5]. To date, the riskfactors linked to immunological nonresponsiveness are alower nadir CD4 cell count before therapy [6], lower pre-HAART HIV RNA levels, older age, male gender, hepatitis Cvirus (HCV) coinfection, injecting drug use (IDU), and ofcourse poor adherence to therapy [7,8]. In addition, onestudy from France showed that Mycobacterium aviumcomplex (MAC) infections also predicted immunologicalnonresponsiveness [9].We reviewed the records of all HAART-nai¨ve patientswith AIDS presenting with CD4 counts of o100cells/mLattwo Infectious Diseases Units in Italy (one located inVerona in the north-east of Italy and the other in Cosenzain the south) and investigated whether opportunisticinfections or cancers recorded at presentation had aneffect on subsequent immune reconstitution on HAART.Fifty-three patients with these characteristics wereidentified in Verona and 20 in Cosenza (73 in total).Fifty-one patients (69%) were men. Their median age was43 years. Thirty-two patients (43%) were men who havesex with men, 15 (20%) were injecting drug users, and theothers were heterosexual. All patients who were injectingdrug users were HCV-coinfected. Twenty patients (27%)had Pneumocystis jiroveci pneumonia, nine (12%) disse-minated MAC infections, eight (11%) cryptococcal menin-gitis, eight (11%) neurotoxoplasmosis, seven (10%) Candidaspp. oesophagitis, six (8%) tuberculosis, six (8%) dissemi-nated Cytomegalovirus infection, four (5%) non-Hodgkin’slymphomas, three (4%) Kaposi’s sarcoma, and two (3%)progressive multifocal leucoencephalopathy.The median CD4 T-cell count at the time of HAARTinitiation was 60.68cells/mL and the median HIV RNA viralload was 572,633HIV-1RNAcopies/mL. The median fol-low-up time was 6.5 years. Six patients were nonadherentand excluded from the analysis.After a median follow-up period of 3 years, all 67adherent patients included in the analysis had sustainedviral load suppression (HIV RNA o50copies/mL), and themedian CD4 T-cell count was 391.79cells/mL.In the analysis of relationships with presenting oppor-tunistic infections or cancers, a lower increase in CD4T-cell count (median 59.75cells/mL) and total lymphocytecount (median 74.21cells/mL) was found only in patientswho had experienced MAC infections. How can MACinfections at presentation negatively influence immunerecovery? A number of hypotheses can be put forward[defects in lymphocytopoiesis resulting from bone marrowinfection, induction of immunosuppressive cytokines,tumour necrosis factor (TNF)-a or apoptosis [10]; long-lasting effects of anti-MAC drugs; MAC-induced low-levelchronic immune activation with its effects on T-cell lifespan [11] and on diminished bone marrow functionthrough TNF-a and transforming growth factor (TGF)-breleased by activated dendritic cells, natural killer cells andT cells], but no definitive data are available and furtherstudies are clearly needed.

Fatal cytomegalovirus infection with CD4+ T-lymphocytopenia durincg corticosteroid therapy for bronchial asthma

An 80-year-old woman was admitted with dyspnea. She had been treated with oral prednisolone for bronchial asthma. She was intravenously treated with dexamethasone. On the 9th day, she presented oliguria and thrombocytopenia. She was diagnosed as dehydration and disseminated intravascular coagulation, and was treated with hydration and heparin infusion. On the 12th day, she presented macroscopic hematuria and melena. Cystoscopy revealed hemorrhagic cystitis. Bone marrow aspiration showed hemophagocytosis. Serum antigen of cytomegalovirus (CMV) was positive. CD4+ T cell count was very low (40/microL). She was diagnosed as disseminated CMV infection, and was treated with gancyclovir and immunoglobulin infusion. On the 14th day, she died of pneumonia. This is the first report of fatal CMV infection during corticosteroid therapy for bronchial asthma.

Fatal Disseminated Cytomegalovirus Infection Associated With Infliximab and 6-Mercaptopurine Therapy in a Child With Crohn Disease

To the Editors: We present a fatal case of cytomegalovirus (CMV) colitis with dissemination in a child with sickle cell anemia and Crohn disease who was receiving infliximab and 6-mercaptopurine. A 9-year-old boy with sickle cell anemia (HbSS) and biopsy-proven Crohn disease, presented with fever, extremity pain, and bloody diarrhea. Treatment included infliximab infusions, the last of which was 5 weeks earlier, and 6-mercaptopurine. On presentation, he was febrile with icteric sclera. Laboratory evaluation was significant for hemoglobin, 6.6 g/dL; leukocyte count, 12,500/mm3; and normal differential and platelet count. Blood culture was negative. Intravenous hydration, vancomycin, and ticarcillin-clavulanate were initiated. His symptoms persisted and abdominal pain developed. Computerized tomography revealed thickening of the colon and a left lower lobe lung infiltrate. Bacterial stool culture and stool for Clostridium difficile toxin were negative. CMV IgM and IgG serologies were positive. CMV was isolated from his urine. Therapy with ganciclovir was initiated and 6-mercaptopurine discontinued. He continued to deteriorate, developing respiratory distress with bilateral pulmonary infiltrates and hypotension. Colonoscopy revealed highly friable mucosa, a biopsy of which showed florid cytopathic effects with typical CMV inclusions and CMV antigen on histoimmunochemical staining. Foscarnet, daily infusions of immune globulin, and antifungal therapy were added. Serologic tests for hepatitis A, B, and C, parvovirus B19, and Epstein-Barr virus were negative, as was an assay for CMV antigen in his peripheral blood leukocytes. He remained febrile, passed frank blood per rectum, developed respiratory and subsequently hepatic failure, and expired 4 weeks after hospitalization. Postmortem evaluation showed diffuse bronchopneumonia and giant cells in the lungs with a single focus positive for CMV antigen. There were acute and chronic inflammatory cells in the esophagus, stomach, pancreas, liver, and spleen. The bowel had extensive ulceration with cryptitis and crypt abscess formation. Lung culture for CMV was negative. Our patient's symptom complex was suggestive of an exacerbation of inflammatory or infectious colitis. CMV colitis was confirmed on pathologic evaluation of colon biopsy specimens. CMV infection was further documented by the detection of IgM and IgG antibodies and the isolation of the virus from urine. It is likely that CMV infection was disseminated because in addition to colitis, he had hepatitis, diffuse pneumonitis with giant cells and a focus with CMV antigen (despite several weeks of antiviral therapy), and clinical sepsis with multiple negative blood cultures. CMV antigen was not detected in peripheral leukocytes; this test was performed after 2 weeks of antiviral therapy. CMV colitis complicating inflammatory bowel disease (IBD) has been described in adults1 and children.2 Withdrawal of immunosuppression with or without antiviral therapy usually resulted in resolution of symptoms. Our patient developed disseminated disease and succumbed despite antiviral therapy, immune globulin infusions, and withdrawal of immunosuppression. We are aware of 1 other report of disseminated CMV infection following infliximab therapy in a person with IBD: a 63-year-old woman with Crohn disease receiving infliximab and corticosteroids, presented with fever, diarrhea, and skin lesions.3 Although our patient had the comorbid condition of sickle cell anemia we are unaware of cases of disseminated CMV disease in patients with sickle cell disease. Clinicians caring for patients with IBD who receive infliximab or other immunosuppressive medications should be vigilant for gastrointestinal CMV infection as well as disseminated CMV disease. Olufunke Pickering, MD Department of Pediatrics Schneider Children's Hospital New Hyde Park, NY Toba Weinstein, MD Division of Pediatric Gastroenterology Schneider Children’s Hospital New Hyde Park, NY Lorry G. Rubin, MD Pediatric Infectious Diseases Schneider Children’s Hospital New Hyde Park, NY