A case of cytomegalovirus colitis during chemotherapy for esophageal cancer

• Published in: Gan to kagaku ryoho Vol. 40; no. 12; p. 2127
• Main Authors: Kitahara, Masahiro, Kanekiyo, Shinsuke, Yamamoto, Tsunenori, Watanabe, Yusaku, Takeda, Shigeru, Ueno, Tomio, Yoshino, Shigefumi, Hazama, Shoichi, Oka, Masaaki
• Format: Journal Article
• Language: Japanese
• Published: Japan 01.11.2013
• Subjects: Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Antiviral Agents - therapeutic use; Cisplatin - administration & dosage; Colitis - drug therapy; Colitis - virology; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - drug therapy; Esophageal Neoplasms - complications; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - surgery; Fatal Outcome; Fluorouracil - administration & dosage; Ganciclovir - therapeutic use; Humans; Male; Middle Aged
• ISSN: 0385-0684

We report a case of a patient who developed cytomegalovirus colitis during chemotherapy for esophageal cancer. A 62- year-old man was admitted to our hospital complaining of epigastralgia and dysphagia. He was diagnosed as having esophageal cancer( Mt, type 3, cT3, cN2, cM0, cStage III). Neoadjuvant chemotherapy with 5-fluorouracil( 5-FU) and cisplatin (CDDP) was initiated. However, after 1 course of chemotherapy, the patient experienced a stroke. Subsequently, he was treated with radical chemoradiotherapy. Chemoradiotherapy with low-dose docetaxel was administered. However, he developed interstitial pneumonia, and thus received pulse corticosteroid therapy with methylprednisolone. On the 26th day after steroid therapy, he developed melena. Colonoscopy revealed multiple punched-out ulcers in the transverse colon, and the patient was diagnosed as having cytomegalovirus colitis on the basis of positive cytomegalovirus antigenemia. Intravenous ganciclovir therapy was initiated. On the 13th day after ganciclovir therapy, the patient required an emergency surgery because of perforation-related peritonitis. We identified a perforation in the ascending colon and performed ileocecal resection. Although he was treated with paclitaxel, he died of esophagotracheal fistula and aspiration pneumonitis. We should be aware of cytomegalovirus colitis during chemotherapy and corticosteroid therapy.