Lai‐Ching Wong

We report a diabetic renal transplant recipient with cytomegalovirus (CMV) disease who presented with tarry stool diarrhea because of multiple colonic ulcerations. Histopathology revealed diffuse colonic ulcers following a process of ischemic vasculitis. The colonic ulcers disappeared dramatically after 2 wk of intravenous ganciclovir therapy. Hyper-immunosuppression was initially suspected but acute rejection (AR) developed after immunosuppressive reduction during the ganciclovir therapy. The AR was successfully reversed and the dosage of cyclosporine was returned to the same level prior to the onset of CMV disease. Our experience suggests that ganciclovir is quite effective for healing colonic ulcers caused by CMV and acute allograft rejection may occur during therapy.

We report a fatal case of cytomegalovirus (CMV) ischemic colitis in a renal transplant recipient. The disease was manifested with fever of unknown origin for 27 days followed by progressive right lower abdominal pain. The clinical condition deteriorated rapidly with development of disseminated intravascular coagulopathy and internal bleeding despite right hemicolectomy and antiviral therapy. The patient died 11 days after the onset of abdominal pain. We conclude that the possibility of CMV ischemic colitis should be suspected if a patient presents with fever and abdominal pain in the early months after transplantation, and that early viral detection by CMV polymerase chain reaction can be lifesaving.

The aim of this study is to evaluate the usefulness of tumor markers in the follow-up of patients with endometrial cancer. The sera of 23 patients with elevated pretreatment CA125, CA15.3, and CA19.9 were collected at each follow-up visit and analyzed. Eleven patients had normal posttreatment levels and none of them developed recurrence. Twelve patients had one or more increased tumor markers, 7 (58.3%) of them developed recurrence. Among these seven patients, six had CA125 elevated by at least 10-fold and one had elevated CA19.9. The median lead time between elevation of tumor markers and clinical evidence of recurrence was 6 months. Hence posttreatment elevation of CA125 is a useful predictor for recurrence in patients with elevated pretreatment levels.

We report a case of acute respiratory distress syndrome (ARDS) and pulmonary granulomatosis after intravenous injection of heroin. This 46-year-old male had a 2-year history of heroin addiction. The recent admission was due to loss of consciousness after intravenous injection of diluted heroin with unknown filler. Initial chest X-ray revealed a picture of ARDS. Blood routine and biochemistry were normal except for leukocytosis. Urine morphine test was positive. The blood and sputum culture yielded no pathogens. After supportive treatment, his condition improved, and the follow-up chest X-ray showed diffuse micronodules in both lung fields. Subsequently, open-lung biopsy of the right upper and lower lobes on the 26th hospital day showed large amounts of foreignbody granulomas distributed over perivascular areas, bronchiolar areas and interstitium. Staining for bacteria, fungi, and mycobacteria was all negative. The morphology of foreign-bodies could be divided into 2 types: 1) periodic acid-Schiff (PAS)-positive, aggregated fine crystals in round form; and 2) PAS-negative, yellow long crystals. The pathological diagnosis of pulmonary granulomatosis was made based on the finding of filler foreign bodies. The nature of these foreign bodies remained undetermined. The case suggests that pulmonary granulomatosis with the radiographic appearance of chronic interstitial pneumonia can occur in patients with a history of heroin use.

A 56-year-old female developed fever and right upper quadrant pain one month after renal transplantation. Computed tomography and barium enema examination revealed irregular thickening and narrowing of the ascending colon extending to the hepatic flexure. Urgent right hemicolectomy was performed as patient's condition deteriorated rapidly. Severe colitis with gangrenous change of ascending colon was evident during the operation. Histopathological examination for the resected specimen revealed cytomegalovirus infection with vasculitis and ischemic colitis. After the development of disseminated intravascular coagulopathy and internal bleeding, the patient unfortunately died four days after operation. Awareness of this rare cause of ischemic colitis is important because of frequent use of immunosuppresants in the organ transplant recipients.