Cytomegalovirus Colitis in the Immunocompetent Host: an Overview

Abstract

This paper describes 2 immunocompetent patients with cytomegalovirus colitis and reviews all previously reported cases (n = 13). Affected patients were generally older (69.13+/-15.62 y-old) with probable reactivation (n = 8) or younger (43.86+/-19.73 y-old) with probable primary infection (n = 7). The onset of illness was found to be hospital-associated in 4 (50.0%) reactivation cases and 1 (14.3%) primary case. Presenting manifestations included diarrhoea (86.7%), fever (80.0%), gastrointestinal bleeding (66.7%) and abdominal pain (60.0%). Endoscopy showed erosive colitis with multiple (n = 11; 73.3%) or single ulcers (n = 2, 13.3%); biopsy was diagnostic in 12/13 (92.3%) patients. Complications included massive haemorrhage (13.3%), toxic megacolon (13.3%), perforation (13.3%) and protracted inflammatory bowel disease (20.0%; exclusively in primary-infection). The mortality rate was 26.7%. Antiviral-agents were given in 8 (53.3%) cases; assessment of treatment-efficacy was not possible. In conclusion, cytomegalovirus colitis in the immunocompetent-host is a rare but potentially severe erosive disease with significant morbidity. It may occur during primary infection or reactivation; the diagnosis requires careful histopathological examination and the benefit of antiviral-therapy is unknown.

Debilitating Chronic Diarrhea Caused by Generalized Gastrointestinal Cytomegalovirus Infection in an Immunocompetent Adult

“…Enterocolitis may manifest with abdominal pain, anorexia, nausea, vomiting, weight loss, watery or bloody diarrhea, hematochezia, and melena [4, 5]. Complications of CMV enterocolitis include massive hemorrhage, megacolon, and perforation and may necessitate surgical intervention [6, 7]. …”

Massive alimentary tract bleeding due to cytomegalovirus infection in an elderly patient

“…Additionally, the sigmoid colon and the rectum are the most affected portions of colon. 1,5,13,14 The antrum is the most common site affected by CMV in the upper gastrointestinal tract.…”

“…22,23 The gastrointestinal complications of CMV infection, which include massive hemorrhage, toxic megacolon, perforation and stenosis, necessitate surgical resection. 5,24 Due to the high risk of complications and mortality from CMV infection in the elderly, all older patients must be offered antiviral treatment as soon as possible. In our case, delay in diagnosis and treatment onset were strongly associated with the fatal outcome.…”

“…4 Many reports show that CMV infection can cause colitis, ulcers, and, very rarely, pseudopolyps, pseudomembranes and even mass lesions. 5-7 The most common manifestations of CMV colitis are diarrhea, fever, gastrointestinal bleeding and abdominal pain. 7,8 We report a case of massive upper and lower gastrointestinal bleeding due to CMV-related duodenal and colonic ulcers in an elderly patient treated for non-Hodgkin lymphoma.…”

Distal Cholangiocarcinoma Associated with Papillitis with Viral CMV Inclusions

“…In immunocompetent patients active infection is uncommon, consisting usually of a mononucleosis-like syndrome, although cases of myocarditis, hepatitis and meningoencephalitis have been described, recovering most patients with no sequelae [1]. Numerous reports show that CMV is a potential pathogen in the gastrointestinal tract, even in immunocompetent patients, where it can produce lesions from the mouth to the anus, the most frequent located in colon-rectum, small intestine, stomach and esophagus [2,3,4,5]. …”