Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5631-5636
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5631
Cytomegalovirus colitis induced segmental colonic hypoganglionosis in an immunocompetent patient: A case report
Ban Seok Kim, Seon-Young Park, Dong Hyun Kim, Nah Ihm Kim, Jae Hyun Yoon, Jae Kyun Ju, Chang Hwan Park, Hyun Soo Kim, Sung Kyu Choi
Ban Seok Kim, Seon-Young Park, Dong Hyun Kim, Jae Hyun Yoon, Chang Hwan Park, Hyun Soo Kim, Sung Kyu Choi, Department of Gastroenterology, Chonnam National University Hospital, Gwangju 501-757, South Korea
Nah Ihm Kim, Department of Pathology, Chonnam National University Hospital, Gwangju 501-757, South Korea
Jae Kyun Ju, Department of Surgery, Chonnam University Hospital, Gwangju 501-757, South Korea
Author contributions: Kim BS and Park SY conceived and designed the study, and contributed to manuscript drafting; Kim DH and Yoon JH performed literature review; Kim NI and Ju JK took the images; Park CH and Kim HS contributed to manuscript drafting; Choi SK reviewed the cases and edited the manuscript; all authors have read and approved the final manuscript.
Supported by Chonnam National University Hospital Research Institute of Clinical Medicine, No. BCRI20023.
Informed consent statement: Written informed consent was obtained from the patient for the publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interests.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Seon-Young Park, MD, PhD, Professor, Department of Gastroenterology, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju 501-757, South Korea. drpsy@naver.com
Received: February 18, 2021
Peer-review started: February 18, 2021
First decision: April 24, 2021
Revised: May 2, 2021
Accepted: June 1, 2021
Article in press: June 1, 2021
Published online: July 16, 2021
Abstract
BACKGROUND

Cytomegalovirus (CMV) colitis is usually seen in immunocompromised patients with risk factors such as human immunodeficiency virus infection, solid organ transplant, inflammatory bowel disease, or malignancy. Therefore, many clinicians usually do not consider the possibility of CMV colitis in immunocompetent patients. We reported a rare case of segmental colonic hypoganglionosis associated with CMV colitis in an immunocompetent patient.

CASE SUMMARY

A 48-year-old woman with no underlying disease was admitted to our hospital for severe abdominal pain and constipation. Computed tomography of the abdomen showed diffuse dilatation of the small intestine and the entire colon. Initial sigmoidoscopic findings and result of polymerase chain reaction (PCR) for CMV revealed the compatible findings of CMV colitis, the patient was treated with intravenous ganciclovir. After treatment, sigmoidoscopic findings and CMV PCR results improved. However the patient continued to suffered from constipation. Eight months after the initial admission, patient visited the emergency department with severe abdominal pain and imaging revealed aggravation of fecal impaction and bowel dilatation. We performed subtotal colectomy to control patient’s symptom. Histological examination of the resected specimen showed significantly reduced number of mature ganglion cells in the sigmoid colon compared to that in the proximal colon.

CONCLUSION

Our case demonstrates that CMV colitis can develop even in patients with no other underlying disease, and that CMV colitis can be one of the causes for developing colonic hypoganglionosis.

Keywords: Colonic pseudo-obstruction, Colitis, Cytomegalovirus, Ganglia, Case report

Core Tip: Cytomegalovirus (CMV) colitis is usually seen in immunocompromised patients such as those with human immunodeficiency virus infection, solid organ transplant, inflammatory bowel disease, or malignancy. In this paper, we report a rare case of CMV colitis induced segmental colonic hypoganglionosis in an immunocompetent patient. This case highlights the importance of clinical suspicion of CMV infection in immunocompetent patients with colonic ulcers and atypical symptoms to ensure its early diagnosis and favorable outcomes.