P0366 - CMV Infection Presenting as Colitis and Pancreatic Insufficiency in an Immunocompetent Patient

Aleena Sammar, MBBS, Nathan Vicknair, DO, Mena Tawfik, MD, Muhammad Sohaib, MD, Amil Shah, DO, Christopher Calcagno, DO, PharmD
Parkview Medical Center, Pueblo, CO

Introduction: Cytomegalovirus (CMV) is a double-stranded DNA virus in the Herpesviridae family. It is common in immunocompromised patients. In immunocompetent hosts, CMV infection usually causes a benign, self-limiting, viral-like syndrome that may resemble mononucleosis. Additional manifestations of CMV can include colitis, hepatitis, and pancreatitis. In this case study, we present a case of CMV infection that led to colitis and exocrine pancreatic insufficiency.

Case Description/Methods: A 43-year-old patient came to the clinic with a history of weight loss and watery diarrhea lasting 3–4 months, occasionally with traces of blood. He had not recently traveled abroad, taken long-term medication, or had any history of inflammatory bowel disease (IBD). Upon physical examination, he appeared malnourished with a BMI of 18.6 kg/m2. Initial tests showed a CRP level of 28 mg/L, fecal calprotectin level of 1840 ug/g, many fecal white blood cells (WBC), and a pancreatic elastase level of 78 mcg/g, indicating severe pancreatic insufficiency. The patient was prescribed Creon. An esophagogastroduodenoscopy (EGD) revealed no abnormalities. A colonoscopy revealed continuous mucosal ulcers with recent bleeding throughout the entire colon, suggestive of severe colitis, and the patient was prescribed mesalamine. Biopsies indicated atypical cells with coarse cytoplasmic granulation consistent with cytomegalovirus (CMV) infection, for which the patient was prescribed valganciclovir. Further testing for HIV, C. difficile, and Shiga toxin were negative. After treatment, the patient reported significant improvement in symptoms, with formed bowel movements and appropriate weight gain. A follow-up colonoscopy was planned, but the patient moved away from the area before it could be completed.

Discussion: CMV infections are rare in immunocompetent patients. In normal hosts, primary infection is usually asymptomatic but sometimes can result in mononucleosis-like syndrome, accompanied by symptoms such as fever, myalgia, cervical lymphadenopathy, and elevated liver enzymes. However, CMV can cause significant morbidity and mortality in immunocompromised patients, especially HIV patients, organ transplant recipients, and newborns. There have been a few documented cases of CMV infections causing hepatitis and pancreatitis. To date, there are no reported cases in the literature of an immunocompetent person with a CMV infection experiencing both colitis and exocrine pancreatic insufficiency.


Disclosures:


Aleena Sammar, MBBS, Nathan Vicknair, DO, Mena Tawfik, MD, Muhammad Sohaib, MD, Amil Shah, DO, Christopher Calcagno, DO, PharmD. P0366 - CMV Infection Presenting as Colitis and Pancreatic Insufficiency in an Immunocompetent Patient, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.