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Kim, Cha, Kim, Jin, Lee, Park, Chang, and Lee: Cytomegalovirus Colitis with Colon Perforation and Lower Gastrointestinal Bleeding in a Immunocompetent Patient
Case Report

The Ewha Medical Journal 2014; 37(2): 105-108.

Published online: 30 September 2014

DOI: https://doi.org/10.12771/emj.2014.37.2.105

Cytomegalovirus Colitis with Colon Perforation and Lower Gastrointestinal Bleeding in a Immunocompetent Patient

Sun Wook Kim, Yoon Jin Cha1, Min Hwan Kim, Moo-Nyun Jin, Jung-Hee Lee, Hye Jung Park, Sooyun Chang, Hyuk Lee2

Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

1Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

2Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

Corresponding author: Hyuk Lee. Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea. Tel: 82-2-3410-3409, Fax: 82-2-3410-6983, leehyuk@skku.edu

Received 27 September 2013       Accepted 21 October 2013

Copyright © 2014. Ewha Womans University School of Medicine

(open-access):

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) infection in immunocompromised patients is associated with significant morbidity, mortality, and adverse clinical outcome. However, CMV infection in immunocompetent patients has been considered to have subclinical and self-limited course, and does not require treatment. We reports a case of CMV colitis, presented with colon perforation and lower gastrointestinal bleeding in a immunocompetent 31-year-old young male. After conservative treatment, colonoscopy revealed multiple ulcers in transverse colon. CMV colitis was confirmed by microscopic findings and immunohistochemistry. After successful treatment with ganciclovir, the patient improved without invasive procedure.

Keywords: Cytomegalovirus, Colitis, Immunocompetence

Figures and Tables

Fig. 1
Abdominal computed tomography shows extraluminal air, wall defect, and pericolic fat infiltration (arrow) in distal transverse colon.
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Fig. 2
Colonoscopic findings. (A) Well demarcated deep ulcer with white exudate in the transverse colon is shown. (B) Healing ulcer after two weeks of antiviral therapy is shown.
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Fig. 3
Microscopic findings of the transverse colon. (A) Enlarged cell (arrow) in the stroma appears intranuclear inclusion (H&E, ×400). (B) Immunoshistochemical staining for CMV shows nuclear positivity in infected cell (×400).
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