Cytomegalovirus colitis masquerading as rectal malignancy in an immunocompetent patient

Abstract

Gastrointestinal tract (GIT) involvement by cytomegalovirus (CMV) infection is well-recognized in immunosuppressed patients but is uncommon in immunocompetent hosts. The colon and esophagus are the most frequently affected sites with punched out ulcers being the characteristic mucosal lesion. CMV-induced pseudotumor is an exceptionally rare presentation, especially in immunocompetent hosts. A 76-year-old immunocompetent female presented with abdominal pain and constipation. Colonoscopy revealed an ulcerated polypoidal tumor-like mass in the anorectal region. Biopsy of the lesion showed large basophilic intranuclear inclusions which were positive for CMV on immunohistochemical staining. The patient responded to 2 weeks of antiviral therapy with complete resolution of the mass. Although rare, pseudotumors associated with CMV infection should be considered in the differential diagnosis of tumorous lesions of the GIT.

Cytomegalovirus induced pseudotumor of the colon in a renal transplanted patient

“…Bowel wall thickening that is seen in patients having CMV infection is histologically due to submucosal edema, granulation tissue along with fibrosis. The histological characteristics of a pseudotumor are inflammatory infiltration in the mucosa and submucosa layers, inclusion bodies mostly in endothelial cells along with extensive fibrosis, granulation tissue, and chronic inflammation (4). Histological examination of our patient revealed the same findings.…”

Spindle Cell Pseudotumor Mimicking Malignancy in an Immunocompetent Patient with a Left Ventricular Assist Device

“…Cytomegalovirus (CMV) infection can occur throughout the gastrointestinal (GI) tract, with the most commonly affected sites being the ileocecal and recto-sigmoid regions, followed by the esophagus. 1 , 2 CMV rarely presents as an intraluminal mass-like lesion, with most reported cases of such “pseudotumors” occurring in the background of immunosuppression, such as with human immunodeficiency virus (HIV) and organ transplantation. 1 - 3 Recognizing that CMV can induce pseudotumor formation is important because these lesions are responsive to anti-retroviral therapy and, in some cases, have been reported to resolve spontaneously.…”

Tocilizumab-induced Cytomegalovirus Colitis in a Patient with COVID-19

“…However, colon involvement is the most common, comprising up to 94% of cases. [8][9][10] For viral reactivation in the immunocompetent, critical illness is a major predisposing factor for developing TI-CMV disease. 11 Endoscopic findings of CMV colitis, like ulcers and inflammation, are similar to UC exacerbation.…”