Cytomegalovirus ileo-pancolitis presenting as toxic megacolon in an immunocompetent patient: A case report

作     者：Joon Hyun Cho Joon Hyuk Choi 

作者机构：Division of Gastroenterology and HepatologyDepartment of Internal MedicineYeungnam University College of MedicineDaegu 42415South Korea Department of PathologyYeungnam University College of MedicineDaegu 42415South Korea 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2020年第8卷第3期

页      面：552-559页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

基　　金：Supported by the 2019 Yeungnam University Research Grant 

主　　题：Toxic megacolon Cytomegalovirus Enterocolitis Immunocompetent Case report 

摘      要：BACKGROUND Cytomegalovirus(CMV) enterocolitis presenting in the form of pancolitis or involving the small and large intestines in an immunocompetent patient is rarely encountered, and CMV enterocolitis presenting with a serious complication, such as toxic megacolon, in an immunocompetent adult has only been reported on a few occasions.CASE SUMMARY We describe the case of a 70-year-old male with no history of inflammatory bowel disease or immunodeficiency who presented with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileopancolitis. The patient was referred to our institute for abdominal pain and distension. Abdominal X-ray showed marked dilatation of ileum and whole colon without air-fluid level, and sigmoidoscopy with biopsy failed to reveal any specific finding. After 7 d of conservative treatment, massive hematochezia developed, and he was diagnosed to have CMV enterocolitis by colonoscopy with biopsy. Although the diagnosis of CMV enterocolitis was delayed, the patient was treated successfully by repeat colonoscopic decompression and antiviral therapy with intravenous ganciclovir.CONCLUSION This report cautions that CMV-induced colitis should be considered as a possible differential diagnosis in a patient with intractable symptoms of enterocolitis or megacolon of unknown cause, even when the patient is nonimmunocompromised.