Published online Feb 6, 2020. doi: 10.12998/wjcc.v8.i3.552
Peer-review started: July 12, 2019
First decision: September 9, 2019
Revised: October 13, 2019
Accepted: October 30, 2019
Article in press: October 30, 2019
Published online: February 6, 2020
Cytomegalovirus (CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with a serious complication, such as toxic megacolon, in an immunocompetent adult has only been reported on a few occasions.
We describe the case of a 70-year-old male with no history of inflammatory bowel disease or immunodeficiency who presented with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileo-pancolitis. The patient was referred to our institute for abdominal pain and distension. Abdominal X-ray showed marked dilatation of ileum and whole colon without air-fluid level, and sigmoidoscopy with biopsy failed to reveal any specific finding. After 7 d of conservative treatment, massive hematochezia developed, and he was diagnosed to have CMV enterocolitis by colonoscopy with biopsy. Although the diagnosis of CMV enterocolitis was delayed, the patient was treated successfully by repeat colonoscopic decompression and antiviral therapy with intravenous ganciclovir.
This report cautions that CMV-induced colitis should be considered as a possible differential diagnosis in a patient with intractable symptoms of enterocolitis or megacolon of unknown cause, even when the patient is non-immunocompromised.
Core tip: Cytomegalovirus (CMV) enterocolitis presenting as toxic megacolon in an immunocompetent patient is rarely encountered. We report the case of a 70-year-old male with a non-immunocompromised state that presented with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileo-pancolitis. Although the diagnosis was delayed until massive hematochezia developed, the patient was treated successfully by repeat colonoscopic decompression and intravenous ganciclovir. A high degree of clinical suspicion is required to diagnose CMV enterocolitis, especially in immunocompetent patients, and this condition should be considered as a possible differential diagnosis in patients with intractable symptoms of enterocolitis or megacolon of unknown cause.