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Lee, Yoon, Lee, Lee, Hong, Lee, Sung, and Shim: Cytomegalovirus Jejunitis Diagnosed with Single-Balloon Enteroscopy
Case Report

Korean J Gastroenterol 2013;62(4):238-242.

Published online: 4 October 2013

DOI: https://doi.org/10.4166/kjg.2013.62.4.238

Cytomegalovirus Jejunitis Diagnosed with Single-Balloon Enteroscopy

Eung Jun Lee, Hyun Sung Yoon, Cho I Lee, Yun Serk Lee, Sung Noh Hong, Sun-Young Lee, In-Kyung Sung, Chan Sup Shim

Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea

Correspondence to: Chan Sup Shim, Department of Internal Medicine, Konkuk University Medical Center, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea. Tel: +82-2-2030-7747, Fax: +82-2-2030-7748, E-mail: csshim@kuh.ac.kr

Received 24 January 2013       Revised 17 April 2013       Accepted 19 April 2013

Copyright © 2013 Korean Ophthalmological Society

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Cytomegalovirus (CMV) infections are usually diagnosed in immunocompromised patients. A 74-year-old male without any significant medical history visited our center because of abdominal pain and diarrhea which began about a month ago. Abdominal computed tomography revealed segmental enhanced bowel wall thickening on jejunum and single-balloon enteroscopy showed multiple geographic shaped ulcerations covered with exudates on proximal jejunum. Biopsy samples taken during endoscopic examination demonstrated necrotic fibrinopurulent tissue debris and benign ulcer. Nested-PCR analysis of CMV DNA from jejunal tissue was positive. The patient was finally diagnosed with CMV jejunitis and was treated by intravenous ganciclovir for 14 days after which, abdominal pain and diarrhea improved. Our case shows that CMV jejunitis can occur in an immunocompetent adult as multiple jejunal ulcers which can be diagnosed using a single-balloon enteroscope.

Keywords: Cytomegalovirus, Double-balloon enteroscopy, Jejunitis

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Fig. 1.
Abdominal CT scan shows segmental enhanced bowel wall thickening on jejunum (arrow).
kjg-62-238f1.tif
Fig. 2.
Single-balloon enteroscopy demonstrates multiple ulcerations covered with exudates and diffuse bowel wall on jejunum (A), along with spontaneous bleeding from the ulcerative lesions (B).
kjg-62-238f2.tif
Fig. 3.
Small bowel series taken three months after ganciclovir treatment shows absence of previously noted multiple ulcerative lesions on jejunum.
kjg-62-238f3.tif
Table 1.
Clinical Characteristics of 12 Cases of Cytomegalovirus Infection in the Small Intestine
Author Year of publication Age(yr)/ Sex Clinical feature Comorbidit y Treatment Outcome
Underwood and Corbett5 1978 68/F Diarrhea None Corticotrophin Died
DeRiso et al.14 1989 40/M Abdominal pain, fever AIDS Surgery and ganciclovir Survived
Nabeshima et al.15 1992 34/M Abdominal pain, loss of appetitie ATLL None Died
Yasunaga et al.16 1995 62/F Abdominal pain NHL Surgery and ganciclovir Survived
Han et al.6 1998 43/M Abdominal pain, hematochezia NHL Surgery and ganciclovir Survived
Ina et al.12 2004 76/M Abdominal pain, nausea, vomiting None Surgery Survived
Petrogiannopoulos et al.13 2004 60/F Blood diarrhea, abdominal pain, fever None Surgery Survived
Mathew et al.17 2005 33/F Gastrointestinal bleeding AIDS Surgery and ganciclovir Survived
Petplook et al.18 2007 75/M Abdominal pain, diarrhea, vomiting None Surgery and ganciclovir Survived
Morunglav et al.19 2010 72/M Abdominal pain, diarrhea None Surgery and ganciclovir Survived
Shah et al.20 2012 50/M Abdominal pain, nausea, diarrhea AIDS Surgery and ganciclovir Survived
Current case   74/M Abdominal pain None Ganciclovir Survived

M, male; F, female; AIDS, acquired immunodeficiency syndrome; ATLL, adult T‐ cell leukemia‐ lymphoma; NHL, Non‐ Hodgkin's lymphoma.

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