Gastrointestinal cytomegalovirus disease secondary to measles in an immunocompetent infant: A case report

Table 1 Laboratory results (international system of units)

Parameter	Reference range	5 d before admission	1 d before admission	On admission	Day 6	Day 12	Day 23	Day 37
Hemoglobin (g/L)	110-160	120	115	79	91	73	126	69
Erythrocytes (× 1012/L)	3.5-5.5	4.70	4.56	2.93	3.21	2.50	3.93	2.34
Leucocytes (× 109/L)	5-12	14.96	9.36	17.87	8.37	20.42	38.68	10.35
Neutrophils (%)	50-70	54.9	32.6	55.1	62.7	61.6	80.4	59.9
Lymphocytes (%)	20-40	36.9	56.7	27	29.3	28.3	15.4	33.4
Atypical lymphocytes (%)	0-2			9	7	0	0	0
Eosinophils (%)	0.02-0.5	1.3	1.4	0.9	0.4	0	0	0
Platelets (× 109/L)	100-300	234	226	769	200	276	165	110
Sedimentation rate (mm/h)	0-15			78		1
C-reactive protein (mg/L)	0-10	39.7		176	80	114	3.7	4.7
Procalcitonin (ng/L)	0-0.5			31.87	0.77		0.31
Sodium (mmol/L)	135-146			116.3	138.4	131.2	139.4	135
Potassium (mmol/L)	3.5-5.5			6.15	4.53	3.9	4.2	3.61
Chloride (mmol/L)	101-111			91.1	102.7	97.8	116.9	110.5
Calcium (mmol/L)	2.25-2.75			1.79	2.46	1.87	2.04	1.66
Magnesium (mmol/L)	0.7-1.15			0.96	0.61	0.53	0.35	0.38
Albumin (g/L)	35-55			25.8	37.3	25.9	15.5	20.6
Globulin (g/L)	20-30			28.1	17.6	19.3	13.2	5.9
Aspartate amino transferase (IU/L)	0-40			70	28	48	85	22
Alanine amino transferase (IU/L)	0-40			61	12	41	53	6
Prothrombin time (s)	9.3-12.9			17.4	19.6	12.5	11.4	16.2
Activated partial thromboplastin time (s)	26.1-40.7			34.5	57.8	38	39.5	55.2
Fecal occult blood test	-			-	+	+	+	+
Fecal white blood cell	-	++	-	-	++	++++	++	-

Table 2 Microbiology results

	Peripheral blood	Feces
Day 1	HBsAg (-); HBsAb (+); HBeAg (-); HBeAb (-); HBcAb (-); TP antibody (-); HIV antibody (-); HCV antibody (-); EBNA IgG (+); EBV-CA IgG (+); EBV-CA IgM (±); EBV-EA IgM (-); EBV DNA < 5.00 × 102 copies/mL (LD)	Norovirus (-); Rotavirus (-); Astrovirus (-); Enteral adenovirus (-); Shigella NA (-); Salmonella NA (-); Widal's test (-)
Day 6	G test (-); EBV DNA < 5.00 × 102 copies/mL (LD)	Norovirus (-); Rotavirus (-); Astrovirus (-); Enteral adenovirus (-)
Day 12	G test (-); Interferon-γ release assay of tuberculosis (-)	Clostridium difficile GDH (-); Clostridium difficile toxin A/B (-)
Day 16	CMV-IgM 11.5 U/mL (ref 0-22); CMV-IgG 18.3 U/mL (ref 0-14); CMV DNA quantitation 9.26 × 103 copies/mL	Clostridium difficile GDH (-); Clostridium difficile toxin A/B (-)
Day 36	CMV DNA quantitation < 5.00 × 102 copies/mL (LD); CMV-IgG 82.2 U/mL (ref 0-14)

HBsAg: Hepatitis B virus surface antigen; HBsAb: Hepatitis B virus surface antibody; HBcAg: Hepatitis B virus core antigen; HBcAb: Hepatitis B virus core antibody; HBeAg: Hepatitis B virus e antigen; TP: Treponemal; HIV: Human immunodeficiency virus; HCV: Hepatitis C virus; EBV-CA: Epstein-Barr virus capsid antigen; EBNA: Epstein-Barr nuclear antigen; EBV-EA: Epstein-Barr virus early antigen; MV: Measles virus; RV: Rubella virus; GDH: Glutamic acid dehydrogenase; LD: Limit of detection; NA: Nucleic acid.

Table 3 Some noninfectious factors in diarrhea

Gastrointestinal diseases	Digestion and absorption disorder
(1) Inflammatory bowel disease; (2) Gastroenteric tumor; (3) Intussusception; (4) Enteric cyst; (5) Duplication of digestive tract; (6) Diverticulosis; (7) Polyposis coli; and (8) Ischemic enteropathy	(1) Short bowel syndrome; (2) Exocrine pancreatic insufficiency; (3) Bile acid-losing syndrome; and (4) Lactose intolerance
Systemic disease: (1) Anaphylactoid purpura; (2) Hyperthyroidism; and (3) Primary chronic adrenocortical hypofunction	Neoplastic diseases: (1) Gastrin adenoma; (2) Carcinoid syndrome; (3) Vasoactive intestinal peptide tumor; and (4) Pheochromocytoma
Allergic diarrhea: (1) Food protein-induced enterocolitis syndrome; (2) food protein-induced proctocolitis; and (3) eosinophilic gastroenteritis	Primary immunodeficiency diseases: (1) Chronic granulomatous disease; (2) Common variable immunodeficiency; and (3) X linked agammaglobulinemia
	Secondary immunodeficiency diseases
	Functional diarrhea
	Drugs/toxicants factor