CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.
Adult ; Antiviral Agents/therapeutic use ; Cytomegalovirus Infections/drug therapy ; Cytomegalovirus Infections/diagnosis ; Cytomegalovirus Infections/complications* ; Disease-Free Survival ; Enteritis/virology ; Enteritis/surgery ; Enteritis/complications ; Ganciclovir/therapeutic use ; Gastrointestinal Hemorrhage/therapy ; Gastrointestinal Hemorrhage/etiology* ; Gastrointestinal Hemorrhage/diagnosis ; Human ; Jejunal Diseases/virology ; Jejunal Diseases/surgery ; Jejunal Diseases/complications* ; Lymphoma, Non-Hodgkin/drug therapy ; Lymphoma, Non-Hodgkin/diagnosis ; Lymphoma, Non-Hodgkin/complications* ; Male ; Opportunistic Infections/drug therapy ; Opportunistic Infections/diagnosis ; Opportunistic Infections/complications* ; Substances: Ganciclovir ; Substances: Antiviral Agents

Hepatitis C virus (HCV) is one of the main viral causes of hepatocellular carcinoma (HCC) and is associated with lymphoproliferative disorder such as non-Hodgkin's lymphoma (NHL). However, there are only few case reports on concomitantly induced NHL and HCC by HCV. Herein, we report a case of synchronous NHL and HCC in a patient with chronic hepatitis C which was unexpectedly diagnosed during liver transplantation surgery. This case suggests that although intrahepatic lymph node enlargements are often considered as reactive or metastatic lymphadenopathy in chronic hepatitis C patients with HCC, NHL should also be considered as a differential diagnosis.
Antineoplastic Agents/therapeutic use ; Carcinoma, Hepatocellular/complications/*diagnosis/radiotherapy ; Drug Therapy, Combination ; Embolization, Therapeutic ; Fluorodeoxyglucose F18 ; Gadolinium DTPA ; Genotype ; Hepatitis B virus/genetics ; Hepatitis C, Chronic/complications/*diagnosis/*virology ; Humans ; Liver Neoplasms/complications/*diagnosis/radiotherapy ; Lymph Nodes/pathology ; Lymphoma, Non-Hodgkin/complications/*diagnosis/drug therapy ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Tomography, X-Ray Computed

We investigated the effectiveness of lamivudine to prevent hepatitis flare up due to reactivation of hepatitis-B virus (HBV) in hepatitis-B surface antigen (HBsAg)-positive patients with Non-Hodgkin's lymphoma (NHL) during cytotoxic chemotherapy. HBsAg-positive patients with NHL were identified from the lymphoma database of the Asan Medical Center from January 1995 to August 2002, and their medical records were reviewed. We found that 31 patients were received cytotoxic chemotherapy among 41 NHL patients with HBsAg-positive during same period. We divided them into 2 groups of HBsAg patients with NHL as follows: Group A who received cytotoxic chemotherapy with lamivudine 100 mg daily; Group B without any prophylactic antiviral therapy. There were no significant differences between Group A and B in several clinical variables. Seventeen patients (85%) in group B and one patient (9%) in Group A had hepatitis due to reactivation of HBV (p<0.001), with one hepatic failure related death in Group B and none in group A. The mean dose intensity of adriamycin actually delivered was 13.3 mg/m2/week (80% Relative Dose intensity (RDI)) in Group A and 9.1 mg/m2/week (55% RDI) in Groups B (p<0.001). Our data suggest that the frequency of chemotherapy-related HBV reactivation may be significantly decreased by lamivudine prophylaxis with maintenance of the dosage of adriamycin.
Adult ; Aged ; Antibiotics, Antineoplastic/*therapeutic use ; Doxorubicin/*therapeutic use ; Female ; Hepatitis B/complications/diagnosis/*drug therapy ; Hepatitis B Surface Antigens/*analysis ; Hepatitis B Virus/metabolism ; Human ; Lamivudine/*therapeutic use ; Lymphoma, Non-Hodgkin/complications/*drug therapy/metabolism ; Male ; Middle Aged ; Reverse Transcriptase Inhibitors/*therapeutic use ; Survival Rate ; Virus Activation