Cytomegaloviral colitis in HIV positive patients: endoscopic findings

Abstract

-Background -Diarrhea in seropositive human immunodeficiency virus patients is one of the most important and disabling symptoms, and often decreases their quality of life. Cytomegalovirus colitis is among the principal causes of this symptom and colonoscopy is the gold standard examination to diagnose it. Aim -To define the main endoscopic findings in seropositive human immunodeficiency virus patients with cytomegalovirus colitis. Methods -Two hundred and forty-three colonoscopies were performed in 200 seropositive human immunodeficiency virus patients with diarrhea associated or not to abdominal pain or gastrointestinal bleeding, over 10-year period, whom 51 patients were diagnosed with cytomegalovirus colitis. Full length colonoscopy with ileum intubation was always tried and multiple biopsies of all segments examined, including endoscopically normal segments, were attempted. All diagnoses were confirmed by histologic and immunohistochemical studies. Results -Total colonoscopy was possible in 98.03% and ileum intubation in 88.23% of these cytomegalovirus colitis patients. At colonoscopy, a heterogeneous ulcerative pattern was presented in 72.54%, an inflammatory process of the mucosa in 21.56% and 5.88% of the patients mucosa was endoscopically normal. Conclusion -Full length colonoscopy with ileum intubation and multiples biopsies of all segments, even when they are endoscopically normal, have always to be attempted in cases of seropositive human immunodeficiency virus patient with diarrhea. HEADINGS -Acquired immunodeficiency syndrome. Colitis. Cytomegalovirus infections. Diarrhea. Colonoscopy.

Human Immunodeficiency Virus-Associated Gastrointestinal Disease: Common Endoscopic Biopsy Diagnoses

“…To identify CMV colitis, colonoscopy is preferred over flexible sigmoidoscopy, as more than one third of affected patients have gross disease restricted to proximal regions of the colon [20]. Endoscopically, CMV colitis may appear as (i) colitis alone (with edema and subepithelial hemorrhage), (ii) colitis with ulceration, or (iii) aggregates of discrete ulcers (ranging from 5 mm to 2 cm) surrounded by unremarkable mucosa (Figure 1) [21, 22]. Occasionally, the colonic mucosa may appear granular and friable, as in ulcerative colitis, or the patient may present with an abdominal mass [18].…”

Idiopathic AIDS Enteropathy and Treatment of Gastrointestinal Opportunistic Pathogens

“…Nearly 15% of CMV infections occur in the GI tract 51 and the prevalence of CMV colitis in HIV patients with diarrhea ranges from 13% to 45%. 52,53 Although there are some data available on the treatment of CMV GI disease, the vast majority of studies have focused on CMV retinitis; treatment recommendations for CMV GI disease have come from these studies. It is important to treat CMV promptly, given its poor prognosis and high rates of recurrence.…”

A Case With Vitamin D Deficiency-Induced Cytomegalovirus Enteritis Presenting as Bowel Pseudo-Obstruction

“…Endoscopic characteristics of CMV colitis included heterogeneous ulcerative pattern, inflammatory process of the mucosa, or normal mucosa [5]. Besides, CMV enterocolitis can also present with pseudo-tumor formation [6].…”