Korean J Gastroenterol.  2013 Oct;62(4):238-242. 10.4166/kjg.2013.62.4.238.

Cytomegalovirus Jejunitis Diagnosed with Single-Balloon Enteroscopy

• Lee EJ
• Yoon HS
• Lee CI
• Lee YS
• Hong SN
• Lee SY
• Sung IK
• Shim CS

• KMID: 1792743
• DOI: http://doi.org/10.4166/kjg.2013.62.4.238

Abstract

Cytomegalovirus (CMV) infections are usually diagnosed in immunocompromised patients. A 74-year-old male without any significant medical history visited our center because of abdominal pain and diarrhea which began about a month ago. Abdominal computed tomography revealed segmental enhanced bowel wall thickening on jejunum and single-balloon enteroscopy showed multiple geographic shaped ulcerations covered with exudates on proximal jejunum. Biopsy samples taken during endoscopic examination demonstrated necrotic fibrinopurulent tissue debris and benign ulcer. Nested-PCR analysis of CMV DNA from jejunal tissue was positive. The patient was finally diagnosed with CMV jejunitis and was treated by intravenous ganciclovir for 14 days after which, abdominal pain and diarrhea improved. Our case shows that CMV jejunitis can occur in an immunocompetent adult as multiple jejunal ulcers which can be diagnosed using a single-balloon enteroscope.

Keyword

Cytomegalovirus; Double-balloon enteroscopy; Jejunitis

MeSH Terms

Aged
Antiviral Agents/therapeutic use
Cytomegalovirus/genetics/isolation & purification
Cytomegalovirus Infections/complications/*diagnosis/drug therapy
DNA, Viral/analysis
Endoscopy, Gastrointestinal
Enteritis/*diagnosis/etiology/virology
Ganciclovir/therapeutic use
Humans
Injections, Intravenous
Jejunal Diseases/*diagnosis/etiology/virology
Male
Polymerase Chain Reaction
Tomography, X-Ray Computed
Antiviral Agents
DNA, Viral
Ganciclovir

Figure

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  Fig. 1. Abdominal CT scan shows segmental enhanced bowel wall thickening on jejunum (arrow).

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  Fig. 2. Single-balloon enteroscopy demonstrates multiple ulcerations covered with exudates and diffuse bowel wall on jejunum (A), along with spontaneous bleeding from the ulcerative lesions (B).

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  Fig. 3. Small bowel series taken three months after ganciclovir treatment shows absence of previously noted multiple ulcerative lesions on jejunum.

Reference

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