ABSTRACT
COVID-19 is a severe disease characterized by a multifactorial immunodeficient state in critically ill patients who have had no prior immunodeficiencies. Much of the mortality in COVID has been attributed to an unprecedented high number of secondary coinfections ranging from bacterial pneumonia to opportunistic infections such as invasive aspergillosis and mucormycosis. Case reports reporting reactivation of cytomegalovirus (CMV) infection are scanty. To the best of our knowledge, we describe one of the very few cases of a previously immunocompetent healthy individual who suffered from reactivation of CMV infection and involvement of invasive infection (CMV pneumonia and CMV colitis).
ABSTRACT
Objectives: Cytomegalovirus (CMV) colitis is generally diagnosed in immunocompromised patients. It is rare for patients who are not immunocompromised to develop CMV colitis. Cases of CMV colitis in patients with inflammatory bowel disease have also been reported. We encountered a case of CMV colitis with a new diagnosis of severe ulcerative colitis and demonstrated the importance of suspecting ulcerative colitis in immunocompetent patients with CMV colitis.Patient: A 78-year-old woman was hospitalized with fever and diarrhea that had lasted for a month. Colonoscopy revealed continuous diffuse edema, mucosal redness, and multiple punched-out ulcers with bleeding, suggesting cytomegalovirus (CMV) colitis, although she was not immunocompromised. Immunohistochemical staining revealed CMV-positive cells, and CMV colitis was diagnosed. One month later, a colonoscopy was conducted owing to persistent symptoms despite initiating the prescribed antiviral drug. A complete loss of vascular pattern, easy bleeding of the crude mucosa, and exacerbation of multiple punched-out ulcers were observed. She was diagnosed with severe ulcerative colitis. The symptoms of ulcerative colitis disappeared with prednisolone and 5-amino salicylic acid treatment.Conclusion: Ulcerative colitis should be suspected in immunocompetent patients with CMV colitis.
ABSTRACT
Acute cytomegalovirus (CMV) infection occurs commonly in immunocompromised and immunocompetent patients, but is usually asymptomatic in the latter. Vascular events associated with acute CMV infection have been described, but are rare. Hence, such events are rarely reported in the literature. We report a case of pulmonary embolism secondary to acute CMV colitis in an immunocompetent 78-year-old man. The patient presented with fever and diarrhea. Colonic ulcers were diagnosed based on colonoscopy findings, and CMV was the proven etiology on pathological examination. The patient subsequently experienced acute respiratory failure. Pulmonary embolism was diagnosed based on the chest radiography and computed tomography findings. A diagnosis of acute CMV colitis complicated by pulmonary embolism was made. The patient was successfully treated with intravenous administration of unfractionated heparin and intravenous ganciclovir.
Subject(s)
Aged , Humans , Administration, Intravenous , Colitis , Colon , Colonoscopy , Cytomegalovirus , Diagnosis , Diarrhea , Fever , Ganciclovir , Heparin , Pulmonary Embolism , Radiography , Respiratory Insufficiency , Thorax , UlcerABSTRACT
Cytomegalovirus (CMV) infection has been described in immunosuppressed individuals such as patients with AIDS, those receiving chemotherapy, and post-transplantation. CMV can cause severe disease either via reactivation of latent virus or via primary infection. In immunocompetent patients, CMV infection is usually transient and does not exhibit many symptoms. The colon is the site most frequently affected by severe CMV disease in immunocompetent patients. Clinically, CMV colitis commonly presents with diarrhea, fever, and abdominal pain. Although some patients recover spontaneously, others suffer from severe complications, such as bowel perforation, severe gastrointestinal bleeding and, rarely, stricture, and surgery is the choice of treatment in these patients. We report a case of stricture of the proximal transverse colon, presenting as a complication of CMV colitis, in an immunocompetent man with acute respiratory distress syndrome. We performed laparoscopic segmental resection of the proximal transverse colon.
Subject(s)
Humans , Abdominal Pain , Colitis , Colon , Colon, Transverse , Constriction, Pathologic , Cytomegalovirus , Diarrhea , Fever , Hemorrhage , Immunocompetence , Laparoscopy , Respiratory Distress Syndrome , VirusesABSTRACT
Cytomegalovirus (CMV) colitis is common among immunocompromised patients, and often diagnosed by pathologic confirmation because it is associated with a diverse spectrum of clinical and endoscopic features. However, Crohn's disease has no definitive diagnostic criteria, but longitudinal ulcers and cobble stone appearance are accepted as typical endoscopic features of Crohn's disease. An 83 year-old male with a history of radiotherapy for hypopharyngeal cancer visited our hospital with a complaint of melena for 1 week. His colonoscopic exam showed multiple longitudinal ulcers along the entire colon. Most of the ulcers were longer than 4 cm, these endoscopic findings were suspected as typical endoscopic features of Crohn's disease. Pathologic reports revealed multiple inclusion bodies with CMV on immunohistochemistry. He was finally diagnosed as having CMV colitis, and received a 3 week-course of intravenous ganciclovir. A colonoscopic follow-up showed complete healing of the multiple longitudinal ulcers, and he is doing well now without further treatment.
Subject(s)
Aged, 80 and over , Humans , Male , Antiviral Agents/therapeutic use , Colitis/diagnosis , Colonoscopy , Crohn Disease/diagnosis , Cytomegalovirus Infections/diagnosis , Ganciclovir/therapeutic use , Immunohistochemistry , Injections, Intravenous , Tomography, X-Ray ComputedABSTRACT
Cytomegalovirus (CMV) colitis is a rare event that has been described mainly in immunocompromised patients who are on immunosuppressive medication or they have HIV infection. CMV colitis manifesting in an immunocompetent host is exceedingly rare, but this has occasionally been described in pregnant patients and patients with chronic renal failure. Pseudomembranous colitis (PMC) is known to develop with long-term antibiotic administration and it is caused by the abnormal overgrowth of toxin-producing Clostridium difficile that colonize the large bowel. Appropriate diagnostic testing and early treatment may avert morbidity and mortality. A case of the simultaneous occurrence of cytomegalovirus and Clostridium difficile colitis in an immunocompetent adult has not yet been reported in the Koran medical literature. We report here on a case of the simultaneous occurrence of cytomegalovirus and Clostridium diffiicle colitis in an immunocompetent Korean adult.
Subject(s)
Adult , Humans , Clostridium , Clostridioides difficile , Colitis , Colon , Cytomegalovirus , Diagnostic Tests, Routine , Enterocolitis, Pseudomembranous , HIV Infections , Immunocompromised Host , Kidney Failure, ChronicABSTRACT
Perforation of the colon occurs in 0.2 to 2% of all colonoscopic examinations. The most common sites of perforation are rectosigmoid junction and cecal area. Colonic perforation, leading to tension pneumoperitoneum in most cases, may be caused by direct trauma or pressurized air. It should be suspected in patients with hypotension, tachycardia and tachypnea during or after the colonoscopy. An 83-year-old woman was admitted due to pulmonary embolism and left cerebellar infarction. Colonoscopy was performed due to bloody diarrhea. She was diagnosed as cytomegalovirus (CMV) colitis. One week after the colonoscopy, colon perforation was incidentally found on ascending colon, and tension pneumoperitoneum occurred immediately after the procedure. The perforated site was primarily closed and the patient discharged 20 days later. Herein, we report a case of tension pneumoperitoneum following colonoscopy in a patient with CMV colitis.
Subject(s)
Aged, 80 and over , Female , Humans , Colitis/diagnosis , Colon/injuries , Colonoscopy/adverse effects , Cytomegalovirus Infections/diagnosis , Intestinal Perforation/etiology , Pneumoperitoneum/etiologyABSTRACT
Cytomegalovirus colitis has been reported infrequently in patients with underlying inflammatory bowel disease, and usually in those who are taking corticosteroid drugs. It has been implicated as a possible exacerbating factor of ulcerative colitis. We experienced a case of cytomegalovirus colitis developed in patient with ulcerative colitis during corticosteroid therapy. So we report the case with a brief review of literatures.
Subject(s)
Humans , Colitis , Colitis, Ulcerative , Cytomegalovirus , Inflammatory Bowel Diseases , UlcerABSTRACT
Cytomegalovirus colitis, invasive cytomegalovirus infection of colon, is an important opportunistic infection in immunosuppressed individuals. The clinical symptoms are abdominal pain, diarrhea, colionic hemorrhage and perforation. The endoscopic appearance show three characteristic features, 1) Focal or diffuse inflammatory changes: erythema, edema and erosion 2) Submucosal hemorrhagic spots 3) Clean-based, well demarcated ulcers(0.5-2 cm) We report a case of cytomegalovirus colitis in 41-year-old male with massive hematochezia, which confirmed by histopathologic findings in autopsy.