Bassem Awada

Introduction: Cytomegalovirus (CMV) and Epstein-Barr virus (EBV) reactivation are known complications in immunocompromised hosts, particularly transplant recipients. However, their occurrence and clinical implications in patients with solid tumors remain underexplored. The introduction of immune checkpoint inhibitors (ICIs) has transformed cancer therapy, but immune-related adverse events (irAEs), including colitis, are increasingly recognized. The potential role of viral reactivation in exacerbating these toxicities is not well established. Cases Presentation: We report two cases of patients with solid tumors treated with ICIs who developed severe, refractory immune-related colitis. Extensive evaluation revealed markedly elevated CMV and EBV viral loads in colonic biopsies, confirmed by histopathology. Both patients showed significant clinical and endoscopic improvement following antiviral therapy with ganciclovir, highlighting the role of CMV and EBV in modulating the severity of ICI-induced colitis. Conclusions: CMV and EBV reactivation may contribute to the persistence or worsening of ICI-induced colitis. Early recognition and treatment of viral reactivation in patients with irAEs may improve outcomes. Clinical judgment and serial viral monitoring are essential for guiding management decisions.

Background: Dacryoadenitis is inflammation of the lacrimal gland, mainly caused by viral infection. It can also be caused by bacterial pathogens and non-infectious processes such as auto-immune diseases and malignancy. Chronic dacryoadenitis is rarely linked to SARS-CoV-2 infection, with only five reports in the literature. Report: A 26-year-old Arab woman experienced chronic inflammatory dacryoadenitis after a mild SARS-CoV-2 infection, which was successfully treated with oral prednisone. Conclusions: Dacryoadenitis can occur due to inflammation caused by either SARS-CoV-2 exposure. The treatment typically involves the administration of steroids, with duration to be decided based on clinical response.

Clostridium cadaveris (C. cadaveris), a strict anaerobic gram-positive rod, is rarely reported in clinical specimens. Since its detection in 1899, it has always been linked to the decay of dead bodies. C. cadaveris is considered non-pathogenic to humans, however infrequently it can cause severe infections including bacteremia. The latter was typically associated with gastro-intestinal pathologies. We report the first case of C. cadaveris invasive infection at Sultanate Oman. The source was most probably an infected decubitus ulcer.