Cytomegalovirus colitis induced segmental colonic hypoganglionosis in an immunocompetent patient: A case report

Abstract

BACKGROUND Cytomegalovirus (CMV) colitis is usually seen in immunocompromised patients with risk factors such as human immunodeficiency virus infection, solid organ transplant, inflammatory bowel disease, or malignancy. Therefore, many clinicians usually do not consider the possibility of CMV colitis in immunocompetent patients. We reported a rare case of segmental colonic hypoganglionosis associated with CMV colitis in an immunocompetent patient. CASE SUMMARY A 48-year-old woman with no underlying disease was admitted to our hospital for severe abdominal pain and constipation. Computed tomography of the abdomen showed diffuse dilatation of the small intestine and the entire colon. Initial sigmoidoscopic findings and result of polymerase chain reaction (PCR) for CMV revealed the compatible findings of CMV colitis, the patient was treated with intravenous ganciclovir. After treatment, sigmoidoscopic findings and CMV PCR results improved. However the patient continued to suffered from constipation. Eight months after the initial admission, patient visited the emergency department with severe abdominal pain and imaging revealed aggravation of fecal impaction and bowel dilatation. We performed subtotal colectomy to control patient’s symptom. Histological examination of the resected specimen showed significantly reduced number of mature ganglion cells in the sigmoid colon compared to that in the proximal colon. CONCLUSION Our case demonstrates that CMV colitis can develop even in patients with no other underlying disease, and that CMV colitis can be one of the causes for developing colonic hypoganglionosis.

Cytomegalovirus Diseases of the Gastrointestinal Tract in Immunocompetent Patients: A Narrative Review

“…Protein-losing enteropathy, or Menetrier’s disease, can be associated, which results in edema and hypoalbuminemia [ 57 , 58 , 59 , 60 , 61 , 62 , 63 ]. CMV post-infectious motility impairment presenting with gastroparesis or constipation (segmental hypoganglionosis) has also been reported [ 64 , 65 ]. With relevant GI segments, preceding bacterial ( Salmonella or Shigella species) infection or concurrent infection with Epstein–Barr virus (EBV), Helicobacter pylori , Clostridioides difficile , histoplasmosis, and other parasites were also noted with CMV TID [ 19 , 51 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ].…”

The Overlooked Agent: Cytomegalovirus Colitis in an Immunocompetent Patient

“…Despite being rare, CMV colitis in immunocompetent individuals has been an increasingly recognizable entity with some underlying conditions being pointed out as risk factors, such as advanced age (above 55 years), diabetes mellitus, chronic renal failure, pregnancy, steroid use, and red blood transfusion. Though, the latter two were the only ones reported as independent risk factors for the development of CMV colitis in this set of patients [3][4][5][6][7]11].…”

“…However, CMV colitis in presumed immunocompetent patients is becoming an increasingly recognizable entity with an increase of reported cases in the last few years and multiple studies pointing out some risk factors such as advanced age (above 55 years), diabetes mellitus, chronic renal failure, pregnancy, steroid use, and red blood cell transfusion, based on the premise that these conditions affect, in one way or another, the immune system [3][4][5][6][7].…”