Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2023; 11(10): 2343-2348
Published online Apr 6, 2023. doi: 10.12998/wjcc.v11.i10.2343
Coexisting cytomegalovirus colitis in an immunocompetent patient with Clostridioides difficile colitis: A case report
Jun Hyoung Kim, Hee-Sung Kim, Hye Won Jeong
Jun Hyoung Kim, Hee-Sung Kim, Hye Won Jeong, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju 28644, Chungbuk, South Korea
Hee-Sung Kim, Hye Won Jeong, Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju 28644, Chungbuk, South Korea
Author contributions: Kim JH contributed to manuscript writing and editing; Kim HS and Jeong HW supervised the study; Jeong HW conceived the study; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient and her family for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hye Won Jeong, MD, PhD, Professor, Department of Internal Medicine, Chungbuk National University College of Medicine, No. 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Chungbuk, South Korea. hwjeong@chungbuk.ac.kr
Received: December 21, 2022
Peer-review started: December 21, 2022
First decision: January 5, 2023
Revised: January 12, 2023
Accepted: March 6, 2023
Article in press: March 6, 2023
Published online: April 6, 2023
Processing time: 99 Days and 10.4 Hours
Abstract
BACKGROUND

Clostridioides difficile (C. difficile) colitis is one of the most common infections in hospitalized patients, characterized by fever and diarrhea. It usually improves after appropriate antibiotic treatment; if not, comorbidities should be considered. Cytomegalovirus (CMV) colitis is a possible co-existing diagnosis in patients with C. difficile infection with poor treatment response. However, compared with immunocompromised patients, CMV colitis in immunocompetent patients is not well studied.

CASE SUMMARY

We present an unusual case of co-existing CMV colitis in an immunocompetent patient with C. difficile infection. An 80-year-old female patient was referred to the infectious disease department due to diarrhea, abdominal discomfort, and fever for 1 wk during her hospitalization for surgery. C. difficile toxin B polymerase chain reaction on stool samples was positive. After C. difficile infection was diagnosed, oral vancomycin treatment was administered. Her symptoms including diarrhea, fever and abdominal discomfort improved for ten days. Unfortunately, the symptoms worsened again with bloody diarrhea and fever. Therefore, a sigmoidoscopy was performed for evaluation, showing a longitudinal ulcer on the sigmoid colon. Endoscopic biopsy confirmed CMV colitis, and the clinical symptoms improved after using ganciclovir.

CONCLUSION

Co-existing CMV colitis should be considered in patients with aggravated C. difficile infection on appropriate treatment, even in immunocompetent hosts.

Keywords: Cytomegalovirus; Clostridioides difficile; Coinfection; Colitis; Immunocompetent; Case report

Core Tip: Cytomegalovirus (CMV) colitis is rare in immunocompetent patients, but colitis is the main clinical manifestation. The Clostridioides difficile (C. difficile) infection and CMV colitis symptoms might be indistinguishable clinically. Therefore, it is difficult to consider their co-existence in patients suspected of C. difficile infection. If a patient treated with C. difficile infection does not show clinical improvement, the possibility of co-existing CMV colitis should be considered as one of the differential diagnoses. Sigmoidoscopy with biopsy is crucial in diagnosing co-existing CMV and C. difficile infection colitis.