Cytomegalovirus enteritis mimicking Crohn’s disease in a lupus nephritis patient: A case report

Abstract

Cytomegalovirus (CMV) infection of the gastrointestinal (GI) tract has been reported in both immunocompetent and, more frequently, in immunocompromised patients. We describe a case of a 19-year-old male who developed CMV infection of the terminal ileum while receiving immunosuppression for lupus nephritis. This was a distinctly unusual site of infection which clinically mimicked Crohn's ileitis. We note that reports of terminal ileal CMV infection have been infrequent. Despite a complicated hospital course, ganciclovir therapy was effective in resolving his symptoms and normalizing his ileal mucosa. This report highlights the importance of accurate histological diagnosis and clinical follow-up of lupus patients with GI symptoms undergoing intense immunosuppression.

Severe viral oesophagitis, pharyngitis, and stomatitis as antecedents of ileocecal Crohn’s disease

“…Radiological, endoscopic, and histological studies allowed us to recognise ileocecal Crohn's disease. The literature reports on acute CMV infections causing ileitis, closely imitating Crohn's disease, and responding well to treatment with ganciclovir [ 12 ]. There are also cases in which intestinal CMV infection occurred simultaneously with the first symptoms of non-specific inflammatory bowel disease, greatly hindering the final diagnosis [ 13 – 15 ].…”

Cytomegalovirus ileocolitis in a rheumatoid arthritis patient: case report and literature review

“…Considering these findings, the initiation of an anti-viral therapy needs to be evaluated on a case-by-case basis. Despite the widespread use of ganciclovir, also valganciclovir combined with foscarnet sodium can still be used in resistant and severe cases (4,6,9,10). The treatment lasts on average 2-4 weeks, and in this case, the patient was treated with valganciclovir.…”

“…It is definitely inevitable in cases where patients are suffering from massive bleeding, intestinal obstruction, perforation, or organ transplantation, due to long-lasting immunosuppressive therapy (3,(9)(10)(11). In a recent study of 44 patients with CMV colitis (age over 55, male, with comorbidities), conditions requiring surgery were regarded as negative survival factors.…”

“…For diagnostic purposes, radiologic, endoscopic, histopathological, and serological methods can be used; however, the primary condition for this diagnosis is to suspect the presence of a CMV infection (4). The presence of intranuclear inclusion particles with enlarged cells, in the histopathologic and immunohistochemical analyses is very important (2,4,7,9,10). In our case, the predominant symptoms of the patient were watery diarrhea and abdominal pain; she was diagnosed by detecting inclusion particles in enlarged cells, along with CMV PCR positivity.…”

The many faces of Crohn’s Disease: Latest concepts in etiology

“…Apart from the common causes of CDS discussed, such as MAP, several less common bacterial, viral, fungal and parasitic candidate agents have also been reported to produce features of the CD Syndrome including Salmonella [58], Histoplasma capsulatum [59], Shigella [60], Cytomegalovirus [61], Schistosomiasis [62] and Strongyloides stercoralis [63]. Despite the obvious distinctions in etiology, the infections discussed above all share the ability to reproduce the essential features of the CD Syndrome.…”