Cytomegalovirus (CMV) is a virus that belongs to the family of Herpesviridae. Infection can cause a serious disease in immunocompromised patients, but it can also affect immunocompetent patients, creating generally self limiting symptoms. However, in some cases it can be fatal. We present a case of CMV ileitis with serious clinical symptoms that led to an operation in an immunocompetent patient.Key words: Ileitis. Cytomegalovirus. Immunocompetent.
INTRODUCTIONCytomegalovirus (CMV) is a form of Herpes virus. In humans, it is known as human herpesvirus 5 (HHV-5). It belongs to the Betaherpesvirinae subfamily of Herpesviridae. The source of the virus name is the size increase observed in the infected cells as a result of the weakening of the cytoskeleton. It can cause serious diseases in immunocompromised patients, either due to the reactivation of a latent infection or to a primo-infection. The CMV infection mainly affects immunocompromised patients. However, it is not rare in immunocompetent patients, and its symptoms are compatible with a non-specific viral syndrome or they simulate a mononucleosis (1,2).CMV infection can affect any system of the body, which, in decreasing order of incidence are: gastrointestinal tract (mainly in the form of colitis), central nervous system (meningitis, encephalitis,…), hematological manifestations (hemolytic anemia, thrombocytopenia), eyes (retinitis, uveitis), liver (hepatitis), lung (pneumonitis) and circulatory system (venous and arterial thrombosis) (3).In the case of gastrointestinal tract, the most common affected areas are the colon and the rectum, and other locations such as the small intestine are rarer. Clinical symptoms include: fever, abdominal pain, anorexia, nausea, vomiting, diffuse abdominal pain, lower abdominal pain, weight loss, diarrhea, hematochezia or melena. Complementary tests for diagnosis include: abdominal ultrasound or CT scan, gastroscopy and colonoscopy with ileoscopy with biopsies and fecal culture. Endoscopic findings include friable or edematous mucosa, fold thickening and, more characteristically, well-delimited medium-or bigsized ulcers with protruding edges separated by normal mucosa. The diagnosis is based on histological analysis, fecal culture, C-reactive protein and serology (4,5). The pathogenesis of these lesions is still unclear, but it seems to be the consequence of ischemic damage to the mucosa secondary to an infection of the vascular endothelial cells and local autoimmune alterations (6).Although this infection is considered to be self-limiting in immunocompetent patients, some cases with serious clinical manifestations that can lead to death have been published (3).
Cytomegalovirus ileitis in an immunocompetent patient
CLINICAL NOTETejedor-Cerdeña María Auxiliadora, Velasco-Guardado Antonio, Fernández-Prodomingo Ana, Piñero-Pérez María Concepción, Calderón Renzo, Prieto-Bermejo Ana Beatriz, Sánchez-Garrido Ana, Martínez-Moreno Juan, Geijo-Martínez Fernando, BlancoMúñez Óscar Javier, Rodríguez-Pérez Antonio. Cytomegalov...
