Journal of Yeungnam Medical Science

Yeungnam University College of Medicine, Yeungnam University Institute Medical Science (영남대 의대 학술지 편집위원회)
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Conservative treatment of cytomegalovirus colitis with bowel perforation in an immunocompetent patient: case report and review of literature

  • Nam, Kyoung Sik (Division of Gastroenterology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Park, Hee Ug (Division of Gastroenterology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Park, Min Gi (Division of Gastroenterology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Park, Su Ho (Division of Gastroenterology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Hwang, Ji Yeon (Division of Gastroenterology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Dong Kyu (Division of Gastroenterology, Department of Internal Medicine, Maryknoll Medical Center) ;
  • Kim, Sung Jun (Division of Gastroenterology, Department of Internal Medicine, Maryknoll Medical Center)
  • Received : 2015.07.02
  • Accepted : 2015.09.07
  • Published : 2017.06.30
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Abstract

Cytomegalovirus (CMV) colitis, which is rare in an immunocompetent patient, was encountered in a 67-year-old man who was admitted due to persistent diarrhea. The first diagnostic tool was colonoscopy, which showed multiple ulcers from cecum to rectum. The secondary tool was CMV polymerase chain reaction, and CMV colitis was diagnosed. Intravenous ganciclovir therapy was administered, which resulted in improvement of diarrhea and ulcers throughout the colon were healed. Asymptomatic colon perforation was detected during diagnostic testing, which improved over the conventional treatment. CMV colitis is rare in immunocompetent patients, but it is essential for the differential diagnosis.

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References

  1. Harano Y, Kotajima L, Arioka H. Case of cytomegalovirus colitis in an immunocompetent patient: a rare cause of abdominal pain and diarrhea in the elderly. Int J Gen Med 2015;8: 97-100.
  2. Chen YM, Hung YP, Huang CF, Lee NY, Chen CY, Sung JM, et al. Cytomegalovirus disease in nonimmunocompromised, human immunodeficiency virus-negative adults with chronic kidney disease. J Microbiol Immunol Infect 2014;47: 345-9. https://doi.org/10.1016/j.jmii.2013.01.011
  3. Pfau P, Kochman ML, Furth EE, Lichtenstein GR. Cytomegalovirus colitis complicating ulcerative colitis in the steroidnaive patient. Am J Gastroenterol 2001;96:895-9. https://doi.org/10.1111/j.1572-0241.2001.03672.x
  4. Lee G, Kim NI, Gu JT, Suh JI, Yang CH, Lee CW. A case of cytomegalovirus colitis in an immunocompetent adult. Korean J Gastroenterol 2000;35:649-53. Korean. https://doi.org/10.1007/s005350070068
  5. Kim SW, Cha YJ, Kim MH, Jin MN, Lee JH, Park HJ, et al. Cytomegalovirus colitis with colon perforation and lower gastrointestinal bleeding in a immunocompetent patient. Ewha Med J 2014;37:105-8. Korean. https://doi.org/10.12771/emj.2014.37.2.105
  6. De la Hoz RE, Stephens G, Sherlock C. Diagnosis and treatment approaches of CMV infections in adult patients. J Clin Virol 2002;25(Suppl 2):S1-12.
  7. Sissons JG, Carmichael AJ. Clinical aspects and management of cytomegalovirus infection. J Infect 2002;44:78-83. https://doi.org/10.1053/jinf.2001.0949
  8. Papadakis KA, Tung JK, Binder SW, Kam LY, Abreu MT, Targan SR, et al. Outcome of cytomegalovirus infections in patients with inflammatory bowel disease. Am J Gastroenterol 2001;96:2137-42. https://doi.org/10.1111/j.1572-0241.2001.03949.x
  9. Gorsane I, Aloui S, Letaif A, Hadhri R, Haouala F, Frih A, et al. Cytomegalovirus ischemic colitis and transverse myelitis in a renal transplant recipient. Saudi J Kidney Dis Transpl 2013;24:309-14. https://doi.org/10.4103/1319-2442.109588
  10. Osawa R, Singh N. Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care 2009;13:R68. https://doi.org/10.1186/cc7875
  11. Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A. Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci 2005;50:609-16. https://doi.org/10.1007/s10620-005-2544-6
  12. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 2008;5:47. https://doi.org/10.1186/1743-422X-5-47
  13. Spencer SP, Power N. The acute abdomen in the immune compromised host. Cancer Imaging 2008;8:93-101. https://doi.org/10.1102/1470-7330.2008.0013
  14. Goodman ZD, Boitnott JK, Yardley JH. Perforation of the colon associated with cytomegalovirus infection. Dig Dis Sci 1979;24:376-80. https://doi.org/10.1007/BF01297124
  15. Emery VC, Sabin CA, Cope AV, Gor D, Hassan-Walker AF, Griffiths PD. Application of viral-load kinetics to identify patients who develop cytomegalovirus disease after transplantation. Lancet 2000;355(9220):2032-6. https://doi.org/10.1016/S0140-6736(00)02350-3
  16. Francis ND, Boylston AW, Roberts AH, Parkin JM, Pinching AJ. Cytomegalovirus infection in gastrointestinal tracts of patients infected with HIV-1 or AIDS. J Clin Pathol 1989;42: 1055-64. https://doi.org/10.1136/jcp.42.10.1055
  17. Ho M. The history of cytomegalovirus and its diseases. Med Microbiol Immunol 2008;197:65-73. https://doi.org/10.1007/s00430-007-0066-x
  18. Blanshard C, Benhamou Y, Dohin E, Lernestedt JO, Gazzard BG, Katlama C. Treatment of AIDS-associated gastrointestinal cytomegalovirus infection with foscarnet and ganciclovir: a randomized comparison. J Infect Dis 1995;172:622-8. https://doi.org/10.1093/infdis/172.3.622