Yonsei Med J.  2010 Mar;51(2):279-283. 10.3349/ymj.2010.51.2.279.

Cytomegalovirus Enteritis Causing Ileal Perforation in an Elderly Immunocompetent Individual

• Cha JM
• Lee JI
• Choe JW
• Joo KR
• Jung SW
• Shin HP
• Choi SI

• KMID: 1126032
• DOI: http://doi.org/10.3349/ymj.2010.51.2.279

Abstract

Cytomegalovirus (CMV) infection is usually subclinical in immunocompetent individuals, however it can be life threatening in an elderly immunocompetent individual. We report a case of CMV enteritis causing ileal perforation in a physically active elderly man. An 88-year-old healthy man presented with abdominal pain and diarrhea. After initial conservative treatment, emergency laparotomy was performed for ileal perforation. The diagnosis of CMV enteritis was based on histological findings revealing many large cells with CMV inclusion bodies in the surgical specimen. In elderly individuals, even though they are immunocompetent, CMV enteritis may result in major complications such as bowel perforation, and it should be included in the differential diagnosis of diarrhea if it is resistant to conventional treatment.

Keyword

Cytomegalovirus; enteritis; perforation; immunocompetent; old age

MeSH Terms

Aged, 80 and over
Cytomegalovirus Infections/*complications/diagnosis
Enteritis/*complications/diagnosis
Humans
Immunocompetence
Intestinal Perforation/*etiology
Male
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Abdominal CT scan revealed extraluminal air in the peritoneal cavity (white arrows), reactive fluid collection, and wall thickening of the distal ileum.

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  Fig. 2 Grossly, the specimen revealed one site of bowel perforation (white arrow), measuring about 3×2 cm, at the proximal 15 cm from the ileocecal valve.

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  Fig. 3 Histological examination revealed ulcerations with acute and chronic inflammatory reaction, and large cells (white arrows) containing cytoplasmic and nuclear inclusions at the perforation site (H&E stain, ×400) (A). These large cells showed strong immunoreactivity to CMV antibody (B). CMV, Cytomegalovirus.

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