CMV proctitis: a rare disease presentation in a young and immunocompetent man

Abstract

A young adult man presented to an outlying emergency department with a sore throat, fever and chills. Upon failure of symptomatic management and a course of amoxicillin, he developed rectal pain and loose stools. Despite outpatient doxycycline treatment for presumed chlamydial proctitis, he developed worsening rectal pain and bloody stools. Results on abdominal and pelvic CT were consistent with proctitis. His symptoms worsened despite added metronidazole for bacterial proctitis. Workup revealed an elevated erythrocyte sedimentation rate, C reactive protein and calprotectin, suggestive of a diagnosis of inflammatory bowel disease (IBD). A colonoscopy revealed proximal tightness of the rectum, and pathology reported features suggestive of IBD. He was treated with prednisone and mesalamine. However, immunostaining positive for cytomegalovirus (CMV) confirmed a diagnosis of tissue-invasive CMV proctitis. This was further supported by serological testing for CMV consistent with a diagnosis of CMV proctitis preceded by a primary CMV infection of the pharynx.

Radiation proctitis with recurrent gastrointestinal bleeding complicated by cytomegalovirus

“…Previously confirmed cases of reactivated CMV proctitis have been attributed to extended hospitalisation, acute severe illness, IBD and stercoral ulceration. 3,4 Our patient required hospitalisations 1-2 months apart on four separate occasions, receiving blood transfusions each time. Ko et al 15 suggest that red blood cell transfusion within 1 month prior to CMV colitis diagnosis is an independent risk factor for CMV colitis development.…”

“…14 CMV proctitis in immunocompetent patients with various risk factors has only been described in case reports. [1][2][3][4] To our knowledge, this is the first case of radiation proctitis in an immunocompetent host with a non-healing CMV-positive rectal ulcer complicated by multiple episodes of lower GI bleeding.…”

“…Reactivation of CMV in the GI tract is not uncommon in immunocompromised patients, but this is rare in immunocompetent hosts. [1][2][3][4] We present the first case report of an immunocompetent patient with multiple episodes of lifethreatening GI bleeding secondary to a CMV-positive rectal ulcer and CMV colitis after receiving radiation therapy for prostate cancer.…”