Abstract
Cytomegalovirus (CMV) typically causes gastrointestinal infections in immunocompetent patients. Colonic perforations secondary to CMV are exceeding rare. We describe a 88-year-old male presenting with a week-long history of intractable abdominal discomfort, bloating, nausea and diarrhea. Flexible sigmoidoscopy revealed significant ulceration with yellowish slough. Emergency surgery was performed subsequently in view of multiple perforations in the rectosigmoid junction. CMV gastrointestinal infections demonstrated an ischemic process secondary to vasculitis, which accelerated the pathway to colonic perforation. CMV gastrointestinal infection should be considered as a differential diagnosis in patients with colonoscopy findings similar to ischemic colitis and Clostridium difficile infections.
References
Cannon M, Schmid D, Hyde T (2010) Review of cytomegalovirus seroprevalence and demographic 10characteristics associated with infection. Rev Med Virol 20(4):202–213
Osawa R, Singh N (2009) Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care 13(3):R68
Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A (2005) Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci 50(4):609–616
Epidemiology, clinical manifestations, and treatment of cytomegalovirus infection in immunocompetent adults (online). https://www.uptodate.com/contents/epidemiology-clinical-manifestations-and-treatment-of-cytomegalovirus-infection-in-immunocompetent-adults. Accessed 15 Oct 2017
Rankin A, Cuthill K, Subesinghe M, Goldsmith D (2009) Life-threatening rectal bleeding due to cytomegalovirus colitis in a haemodialysis patient. Clin Kidney J 2(3):239–241
Muldoon J, O’Riordan K, Rao S, Abecassis M (1996) Ischemic colitis secondary to venous thrombosiS. Transplantation 61(11):1651–1653
Römkens T (2016) Cytomegalovirus in inflammatory bowel disease: a systematic review. World J Gastroenterol 22(3):1321
Shahani L (2012) CMV infection complicating the diagnosis of Crohn’s disease in an immunocompetent patient. BMJ Case Rep. 2012. https://doi.org/10.1136/bcr.11.2011.5254
Tachikawa Y, Nozawa H, Tanaka J, Nishikawa T, Tanaka T, Kiyomatsu T, Hata K, Kawai K, Kazama S, Yamaguchi H, Ishihara S, Sunami E, Kitayama J, Fujisawa M, Takahashi K, Sakaguchi Y, Ushiku T, Fukayama M, Watanabe T (2016) Colonic perforation in a patient with systemic lupus erythematosus accompanied by cytomegalovirus infection: a case report. Int J Surg Case Rep 23:70–73
Chan K, Lee W, Yu W (2016) Coexisting cytomegalovirus infection in immunocompetent patients with Clostridium difficile colitis. J Microbiol Immunol Infect 49(6):829–836
Naseem Z, Hendahewa R, Mustaev M, Premaratne G (2015) Cytomegalovirus enteritis with ischemia in an immunocompetent patient: A rare case report. Int J Surg Case Reps 15:146–148
Barling DR, Tucker S, Varia H, Isaacs P (2016) Large bowel perforation secondary to CMV colitis: an unusual primary presentation of HIV infection. BMJ Case Rep. 2016. https://doi.org/10.1136/bcr-2016-217221
Alves C, Casqueiro J, Casqueiro J (2012) Infections in patients with diabetes mellitus: A review of pathogenesis. Indian J Endocrinol Metab 16(7):27
Lynch H, Goldberg G, Chidgey A, Van den Brink M, Boyd R, Sempowski G (2009) Thymic involution and immune reconstitution. Trends Immunol 30(7):366–373
Salam N, Rane S, Das R, Faulkner M, Gund R, Kandpal U, Lewis V, Mattoo H, Prabhu S, Ranganathan V, Durdik J, George A, Rath S, Bal V (2017) T cell ageing: effects of age on development, survival and function. Indian J Med Res 138(5):595–608
Poon P, Wong C, Fung K, Fong C, Wong E, Lau J, Leung P, Tsui S, Wan D, Waye M, Au S, Lau C, Lam C (2006) Immunomodulatory effects of a traditional Chinese medicine with potential antiviral activity: a self-control study. Am J Chin Med 34(01):13–21
Hasegawa T (2015) Cytomegalovirus colitis followed by ischemic colitis in a non-immunocompromised adult: a case report. World J Gastroenterol 21(12):3750
Mattes F (2000) Histopathological detection of owl’s eye inclusions is still specific for cytomegalovirus in the era of human herpesviruses 6 and 7. J Clin Pathol 53(8):612–614
Goodman AL, Murray CD, Watkins J, Griffths PD, Webster DP (2015) CMV in the gut: a critical review of CMV detection in the immunocompetent host with colitis. Eur J Clin Microbiol Infect Dis 34:13–18
Emery VC, Sabin CA, Cope AV, Gor D, Hassan-Walker AF, Griffths PD (2000) Application of virl-load kinetics to identify patients who develop cytomegalovirus disease after transplantation. Lancet 355(9220):2032–2036
Fisher D, Maple J, Ben-Menachem T, Cash B, Decker G, Early D, Evans J, Fanelli R, Fukami N, Hwang J, Jain R, Jue T, Khan K, Malpas P, Sharaf R, Shergill A, Dominitz J (2011) Complications of colonoscopy. Gastrointest Endosc 74(4):745–752
Jung S (2012) Differential diagnosis of inflammatory bowel disease: what is the role of colonoscopy? Clin Endosc 45(3):254
Lee ES, Jang MK, Park SY, Lee JH, Lee JY, Lim EJ, Kim HS, Lee JH, Lee JY, Kim KH, Park YB, Park JY, Lee JH, Kim HY, Yoo JY (2006) A case of iatrogenic tension pneumoperitoneum following colonoscopy in a patient with cytomegalovirus colitis. Korean J Gastroenterol Taehan Sohwagi Hakhoe Chi 47(4):312–315
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
Not required.
Additional information
Handling Editor: Chan-Shing Lin.
Rights and permissions
About this article
Cite this article
D’cruz, R.T., Lau, C.CL. & Thamboo, T.P. Severe ischemic cytomegalovirus proctocolitis with multiple perforation. Arch Virol 163, 1927–1931 (2018). https://doi.org/10.1007/s00705-018-3792-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00705-018-3792-z