A CLINICO.PATHOLOGICAL STUDY OF ANAL FISTULAE

Anal Fbudr .
Raview of Llterature
Cytomegalovinrs diseasE is the most common serious opportunistic
Pathogen. Gastrointestinal CMV disease is the most common cause for
emsrgency or elEctive abdominal $urgery h AIDS patients( Franh 1984),
Patients with AIDS can have CMV disease of any site in the
gastrointestinal ffact, including the mouth( Marcusen et aI 198f.)
esophagus (Wilcox et aL 1990). Stomach (Hinnant et aL 1986.) small
bowel( Fernandez. et aL I9E6). appendix ftln et aL 1990.). and colon
(Frank et el 1984). Primary peritonitis has been reportedf lfiilcox et aL
1990.)
t
Orsqn Transnlant Recini4t1
Cytomegalovirus is the most conmon infectious complication of
organ transplantationn occurring in 60% to 70% of kidney, liver, bone
marrow, and heart transplant recipients( Rubin 1990). At lest one half of
these infections are symptomatic. Gastrointestinal CMV disease occurs in
about l0% of all transplants( I|'Ieyers et aL 1990). Three descriptive
studies have documented a high incidence (30% to 507o) of asymptomatic
CMV infections in endoscopically normal gastrodudenal mucosa during the
frrst month after transplantation( Spencer. et aL 1986.) However , as in
AIDS patients, symptonratic gastrointestinal CMV has been otserved in all
parts of the gastrointestinal fract, including the esophagus( Spencer. et aL
IgSd), stomach, small intestine( Spencer. et sL 1986),and colon
(Gangahar. et al. I 988.)
#
Case reports and postmortem series have documented severe
ga$trointsstinal CMV disease in'this group of patients mostly in those with
myelo- or lymphoproliferative disorders, particularly thoss treated with
steroids (Naheshim* et aI 1992.1 Oastrointestinal CMV disease was
described in rancer patients well before the AIDS and uansplantation eras
(Goodman et aL l9lSJ,Although CMV ulcers sometimes have preceded
the diagnosis of cance( Furukawa. et aL 1988), more commonly they
have complicated thE clinical course of a patient with an established canser
Nabeshima. et al. 1992.)
Steroid Therapv
Oral, gastric, duodenal, and colonic lesions that contain cytomegatic
cells have been reported in association rvith steroid therapy (Orlolfi Et al.
1989). in patients with cancer (see above); with rheumatic disease (Kanas.
et nl. 1987.) and with asthma (Nabeshima et aL 1992.) Several pathologists
have suggested that steroid- associated peptic ulcer disease is, in fact,
*
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