Tücken der Diagnosestellung und Therapie einer CMV-Kolitis bei einem 30-jährigen HIV-positiven Patienten

Zusammenfassung

Wir berichten über einen 30-jährigen Patienten, der sich mit blutiger Diarrhö vorstellte. Nachdem zunächst unter der Annahme einer bisher nicht diagnostizierten Colitis ulcerosa eine immunsuppressive Therapie eingeleitet wurde, traf eine Woche danach der Erstbefund einer HIV-Infektion im Stadium C2 nach CDC-Klassifikation ein. Neben anderen Infektionen wurde eine CMV-Virämie diagnostiziert. In diesem Fallbericht wird der Behandlungsverlauf mit hochaktiver antiretroviraler Therapie (HAART), Ganciclovir und Prednisolon zusammengefasst und anhand histologischer, immunhistologischer und mikrobiologischer Befunde diskutiert. Der Fall veranschaulicht die Schwierigkeiten der Differenzierung von Colitis ulcerosa, Immunrekonstitutionssyndrom, CMV-Colitis und HIV-assoziierter Diarrhö.

Abstract

We report on a 30-year-old patient who presented with bloody diarrhoea. After initially, assuming a previously not diagnosed ulcerative colitis, an immunosuppressive therapy was initiated, a week later an HIV infection stage C2 according to the CDC classification, complicated by CMV viraemia, was diagnosed. In this case report the course of treatment with highly active antiretroviral therapy (HAART), ganciclovir and prednisolone is reported and discussed on the basis of histological, immunohistochemical and microbiological findings. The case illustrates the difficulty to distinguish between ulcerative colitis, immune reconstitution syndrome, CMV colitis and HIV-associated diarrhoea.

Schlüsselwörter

CMV - chronisch entzündliche Darmerkrankung - HIV

Key words

CMV - chronic inflammatory bowel disease - HIV

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