A Rare Case of Cytomegalovirus in the Gut in an Immunocompetent Host With Ischemic Colitis

Abstract

Cytomegalovirus (CMV) infections are typically seen in individuals with immunosuppressive conditions such as malignancies, HIV/AIDS, and organ transplantation, and in patients on chemotherapy or steroids. Recurrent disease can occur if the virus reactivates due to disruption of immunity due to factors such as older age or immunosuppressive drugs. CMV is common, with a seroprevalence (CMV IgG-positive) of 40-100 % in adults, increasing with age. It has been reported that inflammatory bowel disease in remission can be exacerbated by CMV colitis or complicate steroids refractory colitis flare. For this reason, steroids should be cautiously started if clinical suspicion is high for CMV. We report a unique case of CMV colitis associated with severe ischemic colitis in an immunocompetent patient, with an excellent response to management with antiviral therapy.

The Overlooked Agent: Cytomegalovirus Colitis in an Immunocompetent Patient

“…Among those, only six patients had no reported comorbidities, the remaining 14 had underlying conditions, with hypertension (40%); diabetes mellitus (30%) and chronic renal failure (15%) the most frequent. These findings are consistent with other studies such as the extensive literature review made by Karigane et al, where from all the 33 cases of CMV enteritis or colitis identified the mean age was 68 years old and the meta-analysis performed by Galiatsatos et al where from the all the 44 immunocompetent patients diagnosed with CMV colitis, only 10 had no associated co-morbid conditions [ 6 , 8 , 13 , 15 , 16 ]. Also, a recent study that compared CMV colitis in immunocompromised versus immunocompetent patients found that in the immunocompetent group the patients were older, had more comorbidities and were in worse general condition [ 17 ].…”

“…This highlights the complexity of the diagnosis of CMV colitis in patients that do not fit the classic definition of immunocompromised. Histology findings are essential for the diagnosis and even though “owl eye appearance” intranuclear inclusion bodies are specific for CMV infection, CMV-specific immunohistochemistry (IHC) is considered the diagnostic gold standard due to its high sensibility to detect CMV in tissue biopsies [ 8 , 9 ].…”

“…The diagnosis is based on clinical suspicion and confirmed with CMV-specific immunohistochemistry in tissue biopsies, even though the “owl eye appearance” intranuclear inclusion bodies are specific for CMV infection [ 8 , 9 ]. Early diagnosis and proper management are essential and impact the prognosis.…”

Cytomegalovirus colitis in immunocompetent hosts: A case report and literature review

“…According to the diagnosis, treatment with ganciclovir was started. Finally, the patient was discharged with a favorable general condition and oral ganciclovir 29 . Another atypical presentation was a CMV‐associated tumor at the ileocecal valve of the cecum.…”

“…Finally, the patient was discharged with a favorable general condition and oral ganciclovir. 29 Another atypical presentation was a CMV‐associated tumor at the ileocecal valve of the cecum. After less than 2 months, the patient's clinical symptoms, such as abdominal pain and laboratory tests, were typical.…”