Primary classic Hodgkin lymphoma of the ileum and Epstein-Barr virus mucocutaneous ulcer of the colon: two entities compared.

Primary classic Hodgkin lymphoma of the gastrointestinal tract represents a rare occurrence. A full patient's work-up is essential in order to exclude a secondary intestinal involvement. Histologically Epstein-Barr virus mucocutaneous ulcer closely resembles Hodgkin lymphoma. The differential diagnosis between these two entities is relevant, since both the therapeutic approach and the clinical behavior are different. Herein, we describe a case of primary classic Hodgkin lymphoma arising in the ileum and a case of Epstein-Barr virus mucocutaneous ulcer of the colon, focusing on the main clinicopathological differences.

Post-kidney transplant large bowel lymphoproliferative disorder.

Epstein-Barr virus (EBV)-associated post-transplant lymphoproliferative disorder (PTLD) is a serious complication of organ transplantation. The gastrointestinal (GI) tract is a common site involved, but non-specific signs and symptoms often delay the diagnosis. We report a case of EBV-associated GI-PTLD in a 68-year-old kidney transplant patient who received the kidney ten months earlier. He presented with chronic diarrhea and developed massive pneumo-peritoneum secondary to multiple colonic perforations.

Elucidation of cytomegalovirus disease recurrence in an HIV-1-positive patient.

BACKGROUND: Cytomegalovirus (CMV) is responsible for the most common opportunistic viral infection in patients with acquired immunodeficiency syndrome (AIDS). The colon is a common site for CMV infection in patients positive for the human immunodeficiency virus (HIV). The clinical diagnosis of CMV infection is based on the characteristic endoscopic appearance of extensive ulceration of the gastric mucosa. METHODS: A 54-year-old HIV-positive man visited our hospital because of high fever. The patient presented with diarrhea, and colonoscopy was performed. Ganciclovir was administered, with a good clinical response. However, the patient complained of the same symptoms again 6 months later. Nested polymerase chain reaction (PCR) was performed on all the patient's samples to detect CMV, followed by sequencing of the UL97 gene for CMV resistance detection. RESULTS: The PCR tests for Legionella, Chlamydia pneumoniae, Pneumocystis carinii, and Aspergillus were negative. DNA preparations from biopsy specimens of areas of colon ulceration were positive for CMV. Six months after treating the colon ulcerations, the PCR for CMV was positive, and the possible emergence of CMV mutants conferring ganciclovir resistance was examined. Direct sequencing of the PCR products revealed the known V594 mutation in the UL97 gene predisposing for ganciclovir resistance as well as the polymorphisms (579, GGC-->GGT) and (598, GGT-->GGC) in all samples tested. CONCLUSIONS: In summary, molecular biology methods can be used for early detection of CMV in characteristic colonic lesions in HIV-1-positive patients. Furthermore, detection of mutant strains resistant to antiviral drugs as well as polymorphisms elucidate the natural history of the infection.

Massive lower gastrointestinal hemorrhage caused by CMV disease as a presentation of HIV in an infant.

The gastrointestinal (GI) manifestations of acquired immunodeficiency syndrome in children are related to opportunistic infections like cytomegalovirus (CMV). CMV disease of the GI tract is a major cause of morbidity and mortality in immunocompromised patients: it typically produces mucosal ulcerations that can result in pain, bleeding, diarrhea, and GI perforation, often around the cecum. Preoperative diagnosis may be difficult, plain films and barium enema are often non-specific, and endoscopic evaluation is impossible when there is massive bleeding. The patient usually needs surgery to establish the correct diagnosis and initiate appropriate treatment. The use of gancyclovir for CMV disease in the postoperative period has improved the prognosis.

Post-transplant lymphoproliferative disorder after autologous peripheral stem cell transplantation in a pediatric patient.

Post-transplant lymphoproliferative disorder (PTLD) is a complication of allogeneic bone marrow transplantation (BMT). Rare cases of PTLD after autologous BMT have been reported only in adults. This case report is the first to describe PTLD in a pediatric patient after autologous peripheral stem cell transplantation (PSCT). This 2-year-old male with stage IV neuroblastoma underwent autologous PSCT. The post-PSCT course was complicated by fever with hematochezia and a lung mass. On day 94 post PSCT, colonoscopy revealed an ulcer due to a PTLD, monomorphic type, B cell phenotype, associated with Epstein-Barr virus. Fine needle aspiration identified the lung mass as neuroblastoma. PTLD can occur in pediatric autologous PSCT recipients, and may occur more frequently in autologous grafts manipulated by T cell depletion or CD34+ cell selection.

Churg-Strauss syndrome with perforating ulcers of the colon.

We report a case of a 72-year-old woman with Churg-Strauss syndrome, who presented with intestinal perforation. She has had bronchial asthma with peripheral blood eosinophilia for 30 years. Gross findings of a resected colon showed multiple ulcers with perforation. Histologic findings demonstrated transmural inflammation infiltrated with large numbers of eosionophils, neutrophils and lymphoplasma cells, and characteristic extravascular granuloma in the subserosa. There were multifocally-distributed transmural vasculitis showing all stages of activity in medium and small-sized arteries and veins located in the submucosa, and proper muscle and subserosal layers of the colon, some of which revealed granulomatous inflammation. Histologic finding of liver showed chronic viral hepatitis B with mild inflammatory activity and macronodular cirrhosis. Immunohistochemical findings, acid fuschin orange G staining and electromicroscope found no evidence of hepatitis B virus infection contributing to the pathogenesis of this lesion.