Cytomegalovirus colitis followed by ischemic colitis in a non-immunocompromised adult: A case report

Abstract

We report a rare case of cytomegalovirus (CMV) colitis followed by severe ischemic colitis in a non-immunocompromised patient. An 86-year-old woman was admitted after experiencing episodes of vomiting and diarrhea. The next day, hematochezia was detected without abdominal pain. The initial diagnosis of ischemic colitis was based on colonoscopy and histological findings. The follow-up colonoscopy revealed a prolonged colitis. Immunohistochemical staining detected CMV-positive cells following conservative therapy. Intravenous ganciclovir therapy led to successful healing of ulcers and disappearance of CMV-positive cells. The prevalence of CMV infection is common in adults. CMV colitis is relatively common in immunocompromised patients; however, it is rare in immunocompetent patients. In our case, CMV infection was allowed to be established due to the disruption of the colonic mucosa by the prior severe ischemic colitis. Our experience suggests that biopsies may be necessary to detect CMV and the prompt management of CMV colitis should be instituted when intractable ischemic colitis is observed.

Cytomegalovirus enteritis with ischemia in an immunocompetent patient: A rare case report

“…In otherwise immunocompetent individuals, colitis is the most common gastrointestinal manifestation of CMV [8] . The disease cascade is thought to be initiated by changes in vascular endothelium, with resultant ischemic damage to the mucosa of the colon [9] .…”

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

“…Viral inclusions are often found in endothelial cells but also in macrophages, in epithelial cells, in fibroblasts, and in smooth muscle cells [ 31 , 32 ]. The mechanism of the pathogenesis of CMV colitis remains poorly understood; replication of the virus in endothelial cells could generate vasculitis associated with microvessel thrombosis and local ulceration, which would induce ischemic colitis [ 33 , 34 ]. The recruitment to the mucosa of CMV-infected monocytes promotes the dissemination of inflammatory macrophages in the inflamed tissue [ 35 , 36 ].…”

Cytomegalovirus (CMV): associated ischemic colitis in an immunocompetent patient

“…The most frequent gastrointestinal sites of CMV disease affliction in immunocompetent patients are the colon and the rectum (1)(2)(3)(4)(5). The symptoms of CMV colitis are variable (1)(2)(3)(4)(5). The diagnosis is based on complete colonoscopy and colonic biopsies.…”