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. 2008 Mar 19;70(1):28–31. doi: 10.1007/s12262-008-0006-z

Cytomegalovirus colitis presenting as massive lower gastrointestinal bleeding in an immunocompetent patient

Lee June 1,✉, Ng Chin 1, Deyali Chatterjee 2
PMCID: PMC3452596  PMID: 23133012

Abstract

Cytomegalovirus infection is ubiquitous but often remains asymptomatic in affected patients. Symptomatic cytomegalovirus infection usually occurs in immunocompromised patients— patients who are infected with the Human Immunodeficiency Virus, have received organ transplantations, or are on immunosuppressive therapies. Cytomegalovirus colitis can present with abdominal pain, diarrhea and significant per rectal blood loss. It is a rare entity in immunocompetent patients and can often be missed unless one has a high index of suspicion. We describe a case of CMV colitis in a 78-year-old patient with no known risk factors for immunosuppression who was admitted for respiratory diseases and then subsequently developed transfusion dependent lower gastrointestinal bleeding. She ultimately required surgical resection of her colon. A literature review on CMV colitis, its myriad manifestations and therapeutic outcomes was conducted, with particular emphasis on its occurrence in immunocompetent patients.

Keywords: Cytomegalovirus colitis, Gastrointestinal bleeding, Immunocompetent patient, HIV

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References

  • 1.Goodgame R.W. Gastrointestinal cytomegalovirus disease. Ann Int Med. 1993;119:924–935. doi: 10.7326/0003-4819-119-9-199311010-00010. [DOI] [PubMed] [Google Scholar]
  • 2.Fish K.N., Stenglein S.G., Ibanez C., Nelson J.A. Cytomegalovirus persistence in macrophages and endothelial cells. Scand J Infect Dis. 1995;99:34–40. [PubMed] [Google Scholar]
  • 3.Hinnant K.L., Rotterdam H.Z., Bell E.T., Tapper M.L. Cytomegalovirus infection of the alimentary tract: a clinicopathological correlation. Am J Gastroenterol. 1986;81:944–950. [PubMed] [Google Scholar]
  • 4.Rotterdam H., Tsang P. Gastrointestinal disease in the immunocompromised patient. Hum Pathol. 1994;25:1123. doi: 10.1016/0046-8177(94)90029-9. [DOI] [PubMed] [Google Scholar]
  • 5.Vogel F.S. Enhanced susceptibility of proliferating endothelium to salivary gland virus under naturally occurring and experimental conditions. Am J Pathol. 1958;34:1069–1079. [PMC free article] [PubMed] [Google Scholar]
  • 6.Lee C.S., Low A.H., Ender P.T., Bodenheimer H.C., Jr Cytomegalovirus colitis in an immunocompetent patient with Amebiasis: case report and review of the literature. Mt Sinai J Med. 2004;71:347–350. [PubMed] [Google Scholar]
  • 7.Klauber E., Briski L.E., Khatib R. Cytomegalovirus colitis in the immunocompetent host: an overview. Scand J Infect Dis. 1998;30:559–564. doi: 10.1080/00365549850161098. [DOI] [PubMed] [Google Scholar]
  • 8.Karakozis S., Gongora E., Caceres M., Brun E., Cook J.W. Life-threatening cytomegalovirus colitis in the immunocompetent patient. Report of a case and review of the literature. Dis Colon Rectum. 2001;44:1716–1720. doi: 10.1007/BF02234398. [DOI] [PubMed] [Google Scholar]
  • 9.Sakamoto I., Shirai T., Kamide T., Igarashi M., Koike J., Ito A., et al. Cytomegalovirus enterocolitis in an immunocompetent individual. J Clin Gastroenterol. 2002;34:243–246. doi: 10.1097/00004836-200203000-00010. [DOI] [PubMed] [Google Scholar]
  • 10.Patel S.M., Cohen P., Pickering M.C., Gazzard B.G., Andreyev J. Successful treatment of acute hemorrhagic cytomegalovirus colitis with ganciclovir in an individual without overt immunocompromised. Eur J Gastroenterol Hepatol. 2003;15:1055–1060. doi: 10.1097/00042737-200309000-00020. [DOI] [PubMed] [Google Scholar]
  • 11.Chow P.K., Ho J.M., Ling A.E., Goh H.S. CMV colitis masquerading as colon cancer—an unusual presentation of acquired immunodeficiency syndrome. Singapore Med J. 1997;38:32–34. [PubMed] [Google Scholar]
  • 12.Dieterich D.T., Rahmin M. Cytomegalovirus Colitis in AIDS: presentation in 44 patients and a review of the literature. J Acqu Immune Defic Syndr. 1991;4:S29–S35. [PubMed] [Google Scholar]
  • 13.Swansiger B., Orchard J.L. A colonic mass lesion due to cytomegalovirus in an immunocompromised patient. J Clin Gastroenterol. 1996;22:41–44. doi: 10.1097/00004836-199601000-00012. [DOI] [PubMed] [Google Scholar]
  • 14.Crespo M.G., Arnal F.M., Gomez M., Monserrat L., Suarez F., Rodriguez J.A., et al. Cytomegalovirus colitis mimicking a colonic neoplasm or ischemic colitis 4 years after heart transplantation. Transplantation. 1998;66:1562–1565. doi: 10.1097/00007890-199812150-00023. [DOI] [PubMed] [Google Scholar]
  • 15.Iwasaki T. Alimentary tract lesions in cytomegalovirus infection. Acta Pathol Jpn. 1987;37:549–565. doi: 10.1111/j.1440-1827.1987.tb00389.x. [DOI] [PubMed] [Google Scholar]
  • 16.Nomura K., Kamitsuji Y., Kono E., Matsumoto Y., Yoshida N., Konishi H., et al. Case Report: Severe Cytomegalovirus Enterocolitis after standard chemotherapy for non-Hodgkin’s lymphoma. SCD J Gastroenterol. 2005;40:604–606. doi: 10.1080/00365520510015395. [DOI] [PubMed] [Google Scholar]
  • 17.Keates J., Lagahee S., Crilley P., Haber M., Kowalski T. CMV enteritis causing segmental ischemia and massive intestinal hemorrhage. Gastrointest Endosc. 2001;53:355–359. doi: 10.1016/s0016-5107(01)70417-8. [DOI] [PubMed] [Google Scholar]
  • 18.Galiatsatos P., Shrier I., Lamoureux E., Szilagyi A. Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci. 2005;50:609–616. doi: 10.1007/s10620-005-2544-6. [DOI] [PubMed] [Google Scholar]

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