Cytomegalovirus Colitis: An Uncommon Mimicker of Common Colitides

Abstract

Cytomegalovirus latency, though ubiquitous in the human population, is known to cause colitis in both immunocompromised and immunocompetent hosts. Furthermore, the clinical, endoscopic, and histologic appearance of cytomegalovirus colitis can mimic that of inflammatory bowel disease, an extremely well-documented disease. In this context, though many reports have looked at inflammatory bowel disease with superimposed cytomegalovirus infection, less attention has been paid to cytomegalovirus as a primary cause of isolated colitis. Owing to the rarity of this phenomenon, it is important to consider this diagnosis and implement proper testing to avoid misdiagnosis and mismanagement.

Primary cytomegalovirus infection with invasive disease in a patient with inflammatory bowel disease

“…Although this patient’s initial presentation did not involve GI tract symptoms, during her admission she subsequently developed symptoms and was found to have tissue-invasive disease. CMV infection is commonly considered as a part of the differential diagnosis in patients presenting with IBD flare symptoms given its predilection for the colon 20. Involvement of the oesophagus and duodenum, however, may be more unusual in this population, although CMV oesophagitis is not uncommon in patients with additional immunosuppression or immunodeficiency 21 22.…”

Functional Profile of Human Cytomegalovirus Genes and Their Associated Diseases: A Review

“…In CMV retinitis patients administered with induction therapy with foscarnet, ocular symptoms were initially relieved but recurred soon after stopping the treatment (Heiden et al, 2019). Cidofovir competitively inhibits DNA elongation (Britt and Prichard, 2018) and is helpful for treating colitis (Baniak and Kanthan, 2016). Cottone et al (2001) showed that antiviral treatment can relieve the clinical symptoms of patients (among five patients, three with ganciclovir and two with foscarnet) with ulcerative colitis.…”

Diarrhea in Transplant: Diagnosis and Management

“…While a high CMV viral load in the setting of diarrhea and colitis is suggestive of CMV colitis, histopathology remains the gold standard for diagnosing enteric CMV disease [26,51]. On direct visual examination, CMV disease often appears as occasional erosions, ulcerations, or even mucosal hemorrhages.…”

“…On direct visual examination, CMV disease often appears as occasional erosions, ulcerations, or even mucosal hemorrhages. Less frequently it can cause confluent ulcerations, similar in appearance to inflammatory bowel disease, or even pseudomembranes [51]. Histopathologic features of enteric CMV disease are typically characterized by enlarged cells containing intranuclear inclusion bodies (known as "Cowdry bodies") surrounded by a halo [51].…”

“…Less frequently it can cause confluent ulcerations, similar in appearance to inflammatory bowel disease, or even pseudomembranes [51]. Histopathologic features of enteric CMV disease are typically characterized by enlarged cells containing intranuclear inclusion bodies (known as "Cowdry bodies") surrounded by a halo [51]. Positive immunohistochemical staining for CMV antibodies confirms the diagnosis [26,51].…”