Case Report
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 21, 2016; 22(31): 7166-7174
Published online Aug 21, 2016. doi: 10.3748/wjg.v22.i31.7166
Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review
Jasbir Makker, Bharat Bajantri, Sailaja Sakam, Sridhar Chilimuri
Jasbir Makker, Sridhar Chilimuri, Division of Gastroenterology, Department of Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10457, United States
Bharat Bajantri, Sailaja Sakam, Department of Internal Medicine, Bronx Lebanon Hospital Center, Bronx, NY 10457, United States
Author contributions: Makker J, Bajantri B and Sakam S wrote the manuscript; Chilimuri S reviewed the manuscript.
Conflict-of-interest statement: Authors have no conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Bharat Bajantri, MD, Chief Resident, Department of Internal Medicine, Bronx Lebanon Hospital Center, 1650 Grand Concourse, Bronx, NY 10457, United States.
Telephone: +1-347322-8242 Fax: +1-718518-5111
Received: April 6, 2016
Peer-review started: April 8, 2016
First decision: May 27, 2016
Revised: June 14, 2016
Accepted: June 28, 2016
Article in press: June 28, 2016
Published online: August 21, 2016

Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts. In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids. The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response. Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV. As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality. Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding.

Keywords: Cytomegalovirus, Gastrointestinal, Duodenal bleed, Duodenal hemorrhage

Core tip: Cytomegalovirus (CMV) can establish as latent infection that can lead to reactivation with immunosuppression. It can affect almost any organ system with gastrointestinal tract involvement being most common. In gastrointestinal tract, besides causing mucosal inflammation, rarely gastrointestinal perforation or hemorrhage may occur. High clinical suspicion is needed for timely diagnosis, as clinical signs are usually sparse for this fatal yet treatable CMV infection.