Cytomegalovirus Colitis Mimicking a Colonic Neoplasm or Ischemic Colitis 4 Years After Heart Transplantation

Abstract

CMV colitis should be suspected in any heart transplant patient with signs or symptoms of abdominal pathology, even without classical signs or symptoms of CMV infection. If stenotic lesions are present, surgery may be required not only to remove the obstruction but also to rule out malignancy.

Cytomegalovirus colitis mimicking ischemic colitis in an immunocompetent host

“…Because invasive biopsy is necessary to demonstrate the typical "owl eye" intranuclear inclusion bodies of CMV, diagnosis is often delayed. Reports of CMV colitis in patients who test positive for human immunodeficiency virus have noted the cecum to be the most frequent site of involvement, but a review of CMV colitis in immunocompetent patients noted the sigmoid colon to be most frequently involved [1][2][3][4][11][12][13][14][15][16][17][18] (Table I). In conclusion, this illustrative case presents an immunocompetent patient who presented with signs and symptoms of a nonspecific colitis of uncertain cause, emphasizing the difficulty of distinguishing, both clinically and radiologically, infectious from noninfectious cause.…”

Pseudoneoplastic Appearance of Cytomegalovirus-Associated Colitis in Nonimmunocompromised Patients: Report of 2 Cases

“…The most commonly affected sites included the esophagus [9], the stomach [6,[9][10][11], and the large intestine [6]. Pseudotumoral appearance of HCMV infection has been described mainly in patients who have AIDS [6][7][8][9][10][11] or who have received an organ transplant [7,12,13], although occasional cases were detected in patients with common variable immunodeficiency syndrome [14] or chronic renal failure [15].…”

“…Progressive bowel obstruction and vomiting have also been reported [10]. Radiological studies (barium enema radiography or CT scanning) have shown a concentric or eccentric stenotic area, 5-8 cm long, accompanied by irregular mucosal thickening and rigidity of the wall [12][13][14][15]. The presence of single or multiple ulcerations is common.…”

“…The presence of single or multiple ulcerations is common. Endoscopy usually has detected a friable stenosing lesion or a large intraluminal polypoid mass through which the colonoscope could not be passed, together with ulcers or erosions [9][10][11][12][13]. HCMV infection associated with pseudoneoplastic appearance has been observed in all sections of the large intestine, but the cecum and the transverse colon appear to be more frequently affected [7,10,12,13].…”

Cytomegalovirus colitis presenting as massive lower gastrointestinal bleeding in an immunocompetent patient

“…Endoscopy fi ndings typically show colitis, ulcers and very rarely pseudopolyps, pseudomembranes [7], and even mass lesions [13,14]. Ulcers are typically well defi ned and punched out in appearance [15], but may enlarge and coalesce in the later stage of CMV colitis, producing diffuse redness, erosions, bleeding, and sloughing mucosa throughout the colon [16].…”