Ewha Med J.  2014 Sep;37(2):105-108. 10.12771/emj.2014.37.2.105.

Cytomegalovirus Colitis with Colon Perforation and Lower Gastrointestinal Bleeding in a Immunocompetent Patient

• Kim SW
• Cha YJ
• Kim MH
• Jin MN
• Lee JH
• Park HJ
• Chang S
• Lee H

• KMID: 2171291
• DOI: http://doi.org/10.12771/emj.2014.37.2.105

Abstract

Cytomegalovirus (CMV) infection in immunocompromised patients is associated with significant morbidity, mortality, and adverse clinical outcome. However, CMV infection in immunocompetent patients has been considered to have subclinical and self-limited course, and does not require treatment. We reports a case of CMV colitis, presented with colon perforation and lower gastrointestinal bleeding in a immunocompetent 31-year-old young male. After conservative treatment, colonoscopy revealed multiple ulcers in transverse colon. CMV colitis was confirmed by microscopic findings and immunohistochemistry. After successful treatment with ganciclovir, the patient improved without invasive procedure.

Keyword

Cytomegalovirus; Colitis; Immunocompetence

MeSH Terms

Adult
Colitis*
Colon*
Colon, Transverse
Colonoscopy
Cytomegalovirus*
Ganciclovir
Hemorrhage*
Humans
Immunocompetence
Immunocompromised Host
Immunohistochemistry
Male
Mortality
Ulcer
Ganciclovir

Figure

• 

  Fig. 1 Abdominal computed tomography shows extraluminal air, wall defect, and pericolic fat infiltration (arrow) in distal transverse colon.

• 

  Fig. 2 Colonoscopic findings. (A) Well demarcated deep ulcer with white exudate in the transverse colon is shown. (B) Healing ulcer after two weeks of antiviral therapy is shown.

• 

  Fig. 3 Microscopic findings of the transverse colon. (A) Enlarged cell (arrow) in the stroma appears intranuclear inclusion (H&E, ×400). (B) Immunoshistochemical staining for CMV shows nuclear positivity in infected cell (×400).

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