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Abstract

Cytomegalovirus infection is usually reported in immunocompromised patients. In this study, apparently immunocompetent patients with cytomegaloviral colitis were reviewed. Records with a diagnosis of cytomegaloviral colitis from January 1989 to June 1996 were retrieved for analysis. Ten patients were included (median age 70 yr). The major presenting symptoms were diarrhea and hematochezia. Ulceration was the main macroscopic finding. Rectal bleeding was mostly self-limiting. Three patients developed local complications (rectovaginal fistula in two; rectal stricture in one). In the two patients with rectovaginal fistula, lymphocytes subsets and proliferative response were entirely normal. In the other patient, low B lymphocyte count and low response to mitogen were demonstrated. However, the immunoglobulins were not suppressed and rectal biopsies revealed noncaseating granulomas, suggesting activated cell-mediated immunity. In conclusion, a high index of suspicion is crucial for early diagnosis of cytomegaloviral colitis in patients with bloody diarrhea, even though obvious evidence of immunodeficiency is lacking.

Reactivated cytomegalovirus proctitis in an immunocompetent patient presenting as nosocomial diarrhea: a case report and literature review

“…CMV proctitis and colitis may not be regarded as two distinctive disease entities because these two sites of involvement often occur concomitantly [ 2 , 10 , 12 , 13 ]. However, compared with previous studies of CMV colitis in immunocompetent patients by Polymnia et al (mean age, 61.1 years; DM, 13.6%) [ 14 ] and Karakozis et al (mean age, 63 years) [ 15 ], the 11 cases in our review appeared to be older (mean age, 72 years) and had a higher prevalence of DM (54.5%).…”

Cytomegalovirus infection associated with onset of ulcerative colitis

“…The most common endoscopic abnormality of CMV colitis is multiple ulcers [11,12]. When whole segments of colon are involved, lesions are skipped in CMV colitis [13]. In this case, ulcers were absent.…”

Life-threatening rectal bleeding due to cytomegalovirus colitis in a haemodialysis patient

“…The colon is the most common site for CMV disease in the immunocompetent [ 1 ], the most common symptoms being diarrhoea and rectal bleeding, with or without a fever [ 5–7 ]. Neither radiological investigations such as CT scanning, which may demonstrate bowel wall thickening with inflammatory infiltrates [ 7 ], nor colonoscopy, which may reveal ulceration [ 6 ] and inflammatory polyps [ 5–7 ], is diagnostic, and inflammatory masses visualized at the time of endoscopy can be mistaken for neoplasms, underlining the importance of obtaining a histological diagnosis [ 5 ]. Histology reveals CMV inclusion bodies [ 3 ] seen most commonly in endothelial cells, with ulcers seen in more than 50% [ 3 ]; immunohistochemistry improves the sensitivity of histopathological analysis [ 8 ].…”

“…Patients may suffer diarrhoea, leading to a malnourished state and further risk of infection. Local complications include colonic strictures and fistula formation [ 6 ]. Venous thromboses and pulmonary embolism can occur [ 1 ], and prophylaxis against thromboembolism should be considered.…”