Muhammad YN. Chaudhary, MBChB1, Muhammad Ismail, MD2, Oluwagbenga Serrano, MD, FACG3 1Indiana University Southwest, Evansville, IN; 2Indiana University Southwest, Cedar Rapids, IA; 3Good Samaritan Hospital, Vincennes, IN
Introduction: Hematochezia is a common symptom prompting gastroenterological evaluation. While the differential diagnosis often includes conditions such as hemorrhoids, anal fissures, inflammatory bowel disease (IBD), and colorectal cancer, rare infectious etiologies should also be considered. Cytomegalovirus (CMV) colitis, although typically associated with immunocompromised states, can occasionally present in immunocompetent individuals. This case illustrates a unique instance of CMV colitis in an immunocompetent patient, emphasizing the need for thorough diagnostic consideration in cases of unexplained colonic ulceration.
Case Description/Methods: A 42-year-old male presented with a five-month history of intermittent hematochezia and abdominal discomfort. His medical history included hypertension being treated with amlodipine. No immunocompromising conditions or immunosuppressive medications were identified. Physical examination was normal, and laboratory tests, including a complete blood count and comprehensive metabolic panel, were within normal limits. Due to persistent symptoms, a colonoscopy was performed.
During the colonoscopy, multiple ulcerations ranging from 0.5 cm to 1.5 cm were identified in the transverse and descending colon. Biopsies of these ulcerations and subsequent histopathological examination revealed large cells with intranuclear and cytoplasmic inclusions characteristic of CMV infection. Immunohistochemical staining confirmed the presence of CMV antigens. The patient was diagnosed with CMV colitis and commenced on antiviral therapy, resulting in significant clinical improvement over a six-week period.
Discussion: CMV colitis should be considered as a differential diagnosis of colonic ulceration, even in immunocompetent patients. It is rare in this population, with few reported cases, making this a notable addition to the medical literature. The presentation can mimic more common conditions like IBD or ischemic colitis, often leading to misdiagnosis or delayed treatment.
Complications of CMV colitis can be severe and include massive gastrointestinal bleeding, colonic perforation, and toxic megacolon, all of which can result in significant morbidity and mortality if not promptly recognized and treated. Early recognition and appropriate antiviral therapy are crucial for favorable outcomes. This case highlights the value of colonoscopy with biopsy in establishing an accurate diagnosis, guiding effective management, and preventing complications associated with untreated CMV colitis.
Disclosures:
Muhammad Chaudhary indicated no relevant financial relationships.
Muhammad Ismail indicated no relevant financial relationships.
Oluwagbenga Serrano: MERCK – Stock-publicly held company(excluding mutual/index funds).
Muhammad YN. Chaudhary, MBChB1, Muhammad Ismail, MD2, Oluwagbenga Serrano, MD, FACG3. P3791 - Cytomegalovirus Colitis as an Uncommon Cause of Colonic Ulceration: A Case Report, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
