Digestive Diseases and Sciences

, Volume 54, Issue 9, pp 1864–1867 | Cite as

Crohn’s Colitis Complicated by Cytomegalovirus Infection

  • Barrett G. Levesque
  • Reetesh Pai
  • Christine A. Cartwright
Stanford Multidisciplinary Seminars

Case Presentation and Evolution

A 23-year-old woman developed loose, bloody, bowel movements 1 month after a trip to Italy, and her symptoms subsequently resolved spontaneously. Fifteen months later, she developed left lower quadrant pain, fever, bloody diarrhea, nausea, vomiting, and 27 pounds of weight loss. She was admitted to a local hospital for dehydration and further evaluation.

Past medical history was unremarkable except for exercise-induced asthma. On physical examination, she was thin and tachycardic. Her abdomen was soft and nontender. Laboratory studies showed a white blood cell count of 14,500/mm 3, hemoglobin 7.4 g/dl, albumin 1.9 g/dl, and CRP of 295. Stool cultures, amebic serology, and ova and parasite studies were negative. Anti-neutrophil cytoplasmic (ANCA) antibodies were elevated, and anti-Saccharomyces cerevisiae (ASCA) antibodies were negative. Sigmoidoscopy to the distal sigmoid colon revealed mild diffuse rectosigmoiditis with a few small ulcers in the distal...


Ulcerative Colitis Pretest Probability Bloody Diarrhea Valganciclovir Tumor Necrosis Factor Blocker 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank Dr. Andy Shelton of Colorectal Surgery and Dr. Wes Brown of Infectious Diseases for their expert consultation and care of the patient.


  1. 1.
    Hawk WA, Turnbull RB Jr. Primary ulcerative disease of the colon. Gastroenterology. 1966;51:802–805.PubMedGoogle Scholar
  2. 2.
    Glotzer DJ, Gardner RC, Goldman H, Hinrichs HR, Rosen H. Zetzel L. Comparative features and course of ulcerative and granulomatous colitis. N Engl J Med. 1970;282:582–587.PubMedGoogle Scholar
  3. 3.
    Geboes K, Colombel JF, Greenstein A, et al. Indeterminate colitis: A review of the concept–what’s in a name? Inflamm Bowel Dis. 2008;14:850–857.PubMedCrossRefGoogle Scholar
  4. 4.
    Kambham N, Vij R, Cartwright CA, Longacre T. Cytomegalovirus infection in steroid-refractory ulcerative colitis: A case-control study. Am J Surg Pathol. 2004;28:365–373.PubMedCrossRefGoogle Scholar
  5. 5.
    Reese GE, Constantinides VA, Simillis C, et al. Diagnostic precision of anti-saccharomyces cerevisiae antibodies and perinuclear antineutrophil cytoplasmic antibodies in inflammatory bowel disease. Am J Gastroenterol. 2006;101:2410–2422.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Barrett G. Levesque
    • 1
  • Reetesh Pai
    • 2
  • Christine A. Cartwright
    • 3
  1. 1.Center for Primary Care and Outcomes ResearchStanford University School of MedicineStanfordUSA
  2. 2.Department of PathologyStanford University Medical CenterStanfordUSA
  3. 3.Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordUSA

Personalised recommendations