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| 題 名 | 以腸胃道病變為主要表現的巨細胞病毒感染:一病例報告及文獻回顧=Cytomegalovirus Infection Primarily Manifesting as Gastrointestinal Lesions: A Case Report and Literature Review |
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| 作 者 | 陳瑞灝; | 書刊名 | 內科學誌 |
| 卷 期 | 36:4 2025.08[民114.08] |
| 頁 次 | 頁291-296 |
| 分類號 | 415.231 |
| 關鍵詞 | 巨細胞病毒; 發炎性腸道疾病; 潰瘍性大腸炎; 克隆氏症; 困難梭狀芽孢桿菌感染; Cytomegalovirus; CMV; Inflammatory bowel disease; Ulcerative colitis; UC; Crohn's disease; Clostridium difficile infection; CDI; |
| 語 文 | 中文(Chinese) |
| DOI | 10.6314/JIMT.202508_36(4).07 |
| 中文摘要 | 本報告描述了一名58歲男性患者因巨細胞病毒(Cytomegalovirus, CMV)感染而引發的嚴 重腹瀉和高燒的病例。患者有多重基礎疾病,包括糖尿病、高血壓和冠心症,並於2011年 接受腎移植。手術後出現了一些併發症,手術併發症改善後因腹瀉和發燒再次就醫,最終確 診為CMV感染。這名患住院期間發現其大腸及十二指腸出現黏膜潰瘍,病理切片報告顯示 為CMV感染。這名患者因為腎移植後免疫系統下降而出現腹瀉和發燒,這在CMV感染的患 者中是常見的表現。CMV在免疫功能不全的患者中,可能導致嚴重的臨床症狀,如肝炎、 肺炎、腎炎、胃腸道感染、網膜炎等。正常免疫能力的人通常無症狀或僅有輕微的感冒樣症 狀。在臨床上,CMV腸胃感染需要與其他腸道疾病(如潰瘍性大腸炎、克隆氏症或困難梭狀 芽孢桿菌感染)進行鑒別診斷。患者接受了靜脈注射的ganciclovir治療,這對於免疫功能不全 的患者已被證實是有效的。然而,對於免疫功能正常的重症病人是否需要立即治療CMV感染 仍存在爭議。部分醫師擔心在非免疫功能不全的重症病人中使用抗病毒藥物可能會增加骨髓 抑制的風險。 |
| 英文摘要 | This report describes a case of a 58-year-old male patient who developed severe diarrhea and high fever due to Cytomegalovirus (CMV) infection. The patient had multiple underlying conditions, including diabetes, hypertension, and coronary artery disease, and had undergone a kidney transplant in 2011. After the surgery, he experienced complications, and although those improved, he was readmitted due to diarrhea and fever, eventually being diagnosed with CMV infection.During his hospitalization, mucosal ulcers were found in his colon and duodenum, and pathological examination confirmed CMV infection. The patient’s diarrhea and fever were attributed to his weakened immune system following the kidney transplant, which is a common manifestation of CMV infection. In immunocompromised patients, CMV can lead to severe clinical symptoms such as hepatitis, pneumonia, nephritis, gastrointestinal infections, and retinitis. In contrast, individuals with normal immune function are typically asymptomatic or may only experience mild flu-like symptoms. Clinically, CMV infection needs to be differentiated from other intestinal diseases, such as ulcerative colitis, Crohn’s disease or Clostridium difficile infection. The patient was treated with intravenous ganciclovir, which has been proven effective in immunocompromised patients. However, there is ongoing debate about whether immediate treatment is necessary for critically ill patients with normal immune function. Some physicians are concerned that using antiviral drugs in non-immunocompromised critically ill patients may increase the risk of bone marrow suppression. |
本系統中英文摘要資訊取自各篇刊載內容。