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

Abstract

Gastrointestinal cytomegalovirus (CMV) infection is a common opportunistic infection in immunocompromised patients, especially patients with acquired immunodeficiency syndrome and transplant recipients. In contrast, CMV infection of the gastrointestinal tract is rare in immunocompetent individuals. We report a case of severe, protracted, and debilitating diarrhea caused by generalized CMV infection of the gastrointestinal tract in an elderly woman with no apparent immunosuppression. An extensive diagnostic investigation demonstrated CMV-associated disease affecting both the upper and lower gastrointestinal tracts (esophagus, small intestine, and colon). Such extensive simultaneous involvement of the alimentary tract in an immunocompetent patient is rare and presents a diagnostic and therapeutic challenge. The diagnosis was based on a combination of endoscopic, histopathological, serological, and polymerase chain reaction analysis findings and our patient was successfully treated with intravenous ganciclovir. Our case demonstrates that gastrointestinal CMV infection should be considered in the differential diagnosis of severe chronic diarrhea in immunocompetent patients and that antiviral treatment may be justified in this setting.

Immunostaining Detection of Cytomegalovirus in Gastrointestinal Biopsies: Clinicopathological Correlation at a Large Academic Health System

“…As ulcers increase in depth, erosion into blood vessels can cause profuse bloody diarrhea [9, 10]. Over time, severe inflammation and vasculitis may lead to ischemia and transmural necrosis of the bowel, causing perforation and peritonitis [11]. It is estimated that CMV colitis occurs in 2-16% of patients who have received solid organ transplants, 3-5% of patients with HIV infection or acquired immunodeficiency syndrome (AIDS), and 4-16% in patients with inflammatory bowel disease (IBD) [12, 13].…”

From carcinoma through lymphoma to myeloma: a gastric mass diagnostic rollercoaster ride

“…Pimentel et al 15 and Chim et al 16 described cases of massive upper gastrointestinal bleeding due to gastric plasmacytoma. Telakis et al reported a case of multiple gastric plasmacytomas manifesting as melena in a patient with known MM 17. A similar case of gastric manifestation of a known MM with acute onset of melena in a patient with chronic iron deficiency anaemia was recently published by Wolleb et al 18 Our case describes the dramatic and surprising diagnosis of a MM with predominant extramedullary manifestation in the stomach, initially presenting with an ulcerating gastric mass, ascites, cough due to bilateral pleural effusions and dramatic renal failure after a contrast-enhanced CT.…”