RESUMO
Cytomegalovirus (CMV) disease is a common complication following solid organ transplantation with a variety of gastrointestinal (GI) tract manifestations. CMV appendicitis, however, is a rare complication in a solid organ transplant patient, having been reported only once previously. We have recently seen two cases in solid organ transplant recipients at our institution, one a liver recipient and the other a heart recipient. Both patients underwent surgical resection. Pathologic evaluation of both resected appendices as well as polymerase chain reaction (PCR) amplification for CMV from the serum revealed the virus as the etiology. Both patients received induction intravenous ganciclovir followed by oral valganciclovir and have done well post-operatively. Tissue-invasive CMV disease should be considered in the differential diagnosis for solid organ transplant patients with symptoms suggesting acute or chronic appendicitis. Both PCR testing as well as pathologic review of tissue specimens should be considered to ensure accurate diagnosis and management.
Assuntos
Apendicite/diagnóstico , Apendicite/patologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/patologia , Transplante de Órgãos/efeitos adversos , Transplantados , Adulto , Antivirais/uso terapêutico , Apendicite/etiologia , Apendicite/virologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/tratamento farmacológico , DNA Viral/imunologia , Ganciclovir/análogos & derivados , Ganciclovir/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Resultado do Tratamento , ValganciclovirRESUMO
Colorectal cancer rarely metastasizes to the heart. In the world medical literature, we identified only 7 cases of well-documented colorectal cancer metastasis to the right atrium. Herein, we describe the case of a 72-year-old man in whom metastatic mucinous adenocarcinoma of the colon involved the right atrium and caused superior vena cava syndrome. To our knowledge, this is the first case report of sudden cardiac death due to embolization of metastatic colon cancer from the right atrium. We also present the first comprehensive case series review of this rare entity.Given improvements in diagnostic and therapeutic methods that have increased the longevity of many cancer patients, the detection of cardiac metastases is likely to increase in frequency. Accordingly, we recommend that previously asymptomatic cancer patients with a history of colorectal cancer who develop cardiac symptoms undergo prompt investigation for possible cardiac metastasis.
