Cytomegalovirus Colitis in a Critically Ill Patient Following Severe <i>Legionella</i> Pneumonia with Multiple Organ Failure

Abstract

A 68-year-old man visited an emergency department complaining of dyspnea. He was diagnosed to have Legionella pneumonia with multiple organ failure. Although his multiple organ failure improved, he suffered from persistent abdominal pain and diarrhea with continuous minor bleeding. Colonoscopy revealed a longitudinal ulcer of the rectum, below the peritoneal reflection. He was diagnosed with cytomegalovirus (CMV) colitis. Antiviral therapy with ganciclovir was initiated. He finally underwent a colostomy after a bowel stricture caused an intestinal outlet obstruction, which made oral intake impossible. Based on the present case, we believe that CMV colitis must be considered as one of the differential diagnoses when critically ill patients develop continuous diarrhea and abdominal pain.

Clinical characteristics of cytomegalovirus colitis: a 15-year experience from a tertiary reference center

“…Although CMV colitis was considered rare in immunocompetent hosts, 20 – 22 the recent increase in the number of published case reports of this type, especially involving patients with IBD, critical illness, and end-stage renal disease, drew our attention and concern. 8 , 16 , 23 – 25 However, we could find no study that could predict mortality in such patients. Therefore, we designed the current study to improve this situation.…”