Digestive Diseases and Sciences

, Volume 44, Issue 5, pp 945–952

Cytomegalovirus Colitis in Individuals Without Apparent Cause of Immunodeficiency

  • Fook-Hong Ng
  • Tai-Nin Chau
  • Tak-Cheong Cheung
  • Carolyn Kng
  • Siu-Yin Wong
  • Wing-Fung Ng
  • Kam-Cheong Lee
  • Eric Chan
  • Sik-To Lai
  • Wai-Cheong Yuen
  • Chee-My Chang


Cytomegalovirus infection is usually reported inimmunocompromised patients. In this study, apparentlyimmunocompetent patients with cytomegaloviral colitiswere reviewed. Records with a diagnosis ofcytomegaloviral colitis from January 1989 to June 1996 wereretrieved for analysis. Ten patients were included(median age 70 yr). The major presenting symptoms werediarrhea and hematochezia. Ulceration was the mainmacroscopic finding. Rectal bleeding was mostlyself-limiting. Three patients developed localcomplications (rectovaginal fistula in two; rectalstricture in one). In the two patients with rectovaginalfistula, lymphocytes subsets and proliferative response wereentirely normal. In the other patient, low B lymphocytecount and low response to mitogen were demonstrated.However, the immunoglobulins were not suppressed and rectal biopsies revealed noncaseatinggranulomas, suggesting activated cell-mediated immunity.In conclusion, a high index of suspicion is crucial forearly diagnosis of cytomegaloviral colitis in patients with bloody diarrhea, even though obviousevidence of immunodeficiency is lacking.



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  1. 1.
    Kumar ML, Nankervis GA: Cytomegalovirus infections. South Med J 72:854–861, 1979Google Scholar
  2. 2.
    Stagno S: Cytomegalovirus. In Oxford Text Book of Medicine. DJ Weatherall, JGG Ledingham, DA Warrell (eds). New York, Oxford University Press, 1996, pp 359–363Google Scholar
  3. 3.
    Goodgane RW: Gastrointestinal cytome galovirus disease. Ann Intern Med 119:924–935, 1993Google Scholar
  4. 4.
    Hinnant KL, Rotterdam HZ, Bell ET, Tapper ML: Cytomegalovirus infection of the alimentary tract: A clinicopathological correlation. Am J Gastroenterol 81:944–950, 1986Google Scholar
  5. 5.
    Cheung ANY, Ng IOL: Cytomegalovirus infection of the gastrointestinal tract in non-AIDS patients. Am J Gastroenterol 88:1882–1886, 1993Google Scholar
  6. 6.
    Surawicz CM, Myerson D: Self-limited cytome galovirus colitis in immunocompetent individuals. Gastroenterology 94:194–199, 1988Google Scholar
  7. 7.
    Spielgel JS, Schwabe AD: Disseminated cytome galovirus infection with gastrointestinal involvement. Am J Gastroenterol 73:37–44, 1980Google Scholar
  8. 8.
    Maignan M, Wahl D, Thiaucourt D, Bach D, De Korwin JD, Vaillant G, Paille F, Schmitt J: Self-limited primary cytomegalovirus colitis in an immunocompetent individual. J Intern Med 232:357–359, 1992Google Scholar
  9. 9.
    Diepersloot RJA, Kroes ACM, Visser W, Jiwa NM, Rothbarth PH: Acute ulcerative protocolitis associated with primary cytomegalovirus infection. Arch Intern Med 150:1749–1750, 1990Google Scholar
  10. 10.
    Falagas ME, Griffiths J, Prekezes J, Worthington M: Cytomegalovirus colitis mimicking colon carcinoma in an HIV-negative patient with chronic renal failure. Am J Gastroenterol 91:168–169, 1996Google Scholar
  11. 11.
    Coll PP, Pacala J, Hamilton CW: Cytomegalovirus colitis in an older woman, successfully treated with ganciclovir. J Fam Prac 34:772–775, 1992Google Scholar
  12. 12.
    Machens A, Bloechle C, Achilles EG, Bause WH, Izbicki JR: Toxic megacolon caused by cytome galovirus colitis in a multiply injured patient. J Trauma 40:644–646, 1996Google Scholar
  13. 13.
    Ho M: Epidemiology of cytomegalovirus infection. Rev Infect Dis 12:S701–S710, 1990Google Scholar
  14. 14.
    Rosen P, Armstrong D, Rice N: Gastrointestinal cytome galovirus infection. Arch Intern Med 132:274–276, 1973Google Scholar
  15. 15.
    Levine R, Warnker N, Johnson C: Cytomegalovirus inclusion disease in the gastrointestinal tract of adults. Ann Surg 159:37–48, 1964Google Scholar
  16. 16.
    Dieterich DT, Rahmin M, Johnson C: Cytomegalovirus colitis in AIDS: Prese ntation in 44 patients and a review of the literature. J AIDS 4:S29–S35, 1991Google Scholar
  17. 17.
    Sutheriand DE, Chan FY, Foucar K, Simmons RL, Howard RJ, Najarian JS: The bleeding cecal ulcer in transplant patients. Surgery 86:386–398, 1979Google Scholar
  18. 18.
    Cho SR, Tisnado J, Liu CL, Beachley MC, Shaw CI, Kipreos BE, Schneider V: Bleeding cytome galovirus ulcers of the colon: barium enema and angiography. AJR 136:1213–1215, 1981Google Scholar
  19. 19.
    Rene E, Marche C, Chevalier T, Rouzious C, Regnier B, Saimot AG, Negesse Y, Matherson S, Leport C, Wolff B, Moriniere B, Katlama C, Godeberge B, Vittecoq B, Bricaire F, Brun-Vesinet C. Cytomegalovirus colitis in patients with acquired immunodeficiency syndrome. Dig Dis Sci 33:741–750, 1988Google Scholar
  20. 20.
    Teixidor HS, Honig CL, Norsoph E: Cytomegalovirus infection of the alimentary canal: Radiologicfindings with pathologic correlation. Radiology 163:317–323, 1987Google Scholar
  21. 21.
    Chau TN, Lau LK, Lee KC, Kwok ML, Lai ST, Yuen H: Association of self-limited cytome galovirus colitis and shigellosis in an immunocompetent patient. Eur J Gastroenterol Hepatol 8:819–822, 1996Google Scholar
  22. 22.
    Peters BS, Becks EJ, Anderson S, Coleman D, Coker R, Main J, Migdal C, Harris JR, Pinching AJ: Cytomegalovirus infection in AIDS. Patterns of diseases, response to therapy and trends in survival. J Infect 23:129–137, 1991Google Scholar
  23. 23.
    Drew WL: Cytomegalovirus infection in patients with AIDS. J Infect Dis 158:449–456, 1988Google Scholar
  24. 24.
    Griffiths PD, Grundy JE: Molecular biology and immunology of cytomegalovirus. Biochemistry 241:313–324, 1987Google Scholar
  25. 25.
    Crowe S, Mills J: Infections of the immune system. In Basic and Clinical Immunology, 7th ed. DP Sitetes, AI Terr (eds). Prentice-Hall, Englewood Childs, New Jersey.Google Scholar
  26. 26.
    Frank TS, Himebaugh KS, Wilson MD: Granulomatous endome tritis associated with histologically occult cytome galovirus in a healthy patient. Am J Surg Pathol 16:716–720, 1992Google Scholar
  27. 27.
    Lobdell DH: `Ring' granulomas in cytomegalovirus hepatitis. Arch Pathol Lab Med 111:881–882, 1987Google Scholar
  28. 28.
    Grundy JE: Virologic and pathogenetic aspects of cytomegalovirus infection. Rev Infect Dis 12( suppl 7):S711–S719, 1990Google Scholar

Copyright information

© Plenum Publishing Corporation 1999

Authors and Affiliations

  • Fook-Hong Ng
  • Tai-Nin Chau
  • Tak-Cheong Cheung
  • Carolyn Kng
  • Siu-Yin Wong
  • Wing-Fung Ng
  • Kam-Cheong Lee
  • Eric Chan
  • Sik-To Lai
  • Wai-Cheong Yuen
  • Chee-My Chang

There are no affiliations available

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