Refractory Protein-losing Enteropathy Complicated by Cytomegalovirus Enterocolitis after Chemotherapy for Multiple Myeloma: A Fatal Adult Case.

Abstract

Protein-losing enteropathy (PLE) complicated by cytomegalovirus (CMV) enterocolitis is rare in adults. We report a fatal case of refractory PLE complicated by CMV enterocolitis after chemotherapy for multiple myeloma. A 71-year-old woman developed severe diarrhea and hypoalbuminemia after a single course of bortezomib-based therapy. CMV enterocolitis was diagnosed by an endoscopic biopsy despite initially negative blood CMV DNA. Although antiviral therapy controlled the CMV infection, PLE and intestinal ulceration persisted, leading to perforation and uncontrollable gastrointestinal bleeding. This case highlights the importance of early consideration of CMV enterocolitis and prompt colonoscopic evaluation in patients with persistent diarrhea and hypoalbuminemia following chemotherapy.