Cytomegalovirus Colitis and Subsequent New Diagnosis of Inflammatory Bowel Disease in an Immunocompetent Host: A Case Study and Literature Review

Abstract

Patient: Male, 40Final Diagnosis: CMV colitisSymptoms: Abdominal pain • diarrhea • jaundiceMedication: —Clinical Procedure: Flexible sigmoidoscopy • colonoscopySpecialty: Family MedicineObjective:Rare co-existance of disease or pathologyBackground:Infection with gastrointestinal cytomegalovirus in an immunocompetent host is a rather rare occurrence in the literature. There are a few reports of gastrointestinal infection in the immunocompetent who are then subsequently given a new diagnosis of inflammatory bowel disease. It is speculated that the initial cytomegalovirus colitis infection triggers the onset of inflammatory bowel disease.Case Report:Herein we report a case of cytomegalovirus colitis and new diagnosis of inflammatory bowel disease identified in a 40-year-old immunocompetent adult man who presented with gastrointestinal symptoms and disseminated cytomegalovirus infection requiring anti-viral therapy, which successfully treated the episode of cytomegalovirus infection. He then went on to have persistent symptomatic inflammatory bowel disease confirmed by pathology.Conclusions:In this paper we will review the literature and explore the rare case of cytomegalovirus colitis in the immunocompetent host and discuss the pathology, physiology, diagnosis, and treatment of cytomegalovirus colitis.

Patient characteristics, clinical manifestations, prognosis, and factors associated with gastrointestinal cytomegalovirus infection in immunocompetent patients

“…Patients were separated into either the immunocompromised group or the immunocompetent group. Patients with AIDS, with organ transplantation, and/or receiving chemotherapy, systemic corticosteroids, or immunosuppressive agents were defined as immunocompromised in previous reports [7,30,31]. All other patients were considered to be immunocompetent.…”

Acute cytomegalovirus infection in an immunocompetent patient with ulcerative colitis: A case report

“…CMV is a ubiquitous member of the Herpesviridae family that can present with a variety of clinical manifestations, including encephalitis, retinitis, interstitial pneumonia, and colitis (17). These serious symptoms are generally observed as opportunistic infections in immunocompromised hosts, including patients with AIDS and those receiving steroids and/or immunosuppressants (9). Patients with severe or uncontrollable UC often require administration of a steroid or immunosuppressant to decrease disease activity.…”

“…Recently, a high prevalence of CMV infection of the colon has been reported in patients with inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC) (5)(6)(7). Most cases of CMV colitis in patients with IBD can be attributed to the reactivation of a latent CMV infection; active colonic infection induced by a primary CMV infection is rare (5,8,9). In addition, CMV infection of the colon exacerbates IBD, particularly in association with severe or refractory cases under steroid and/or immunosuppressive therapies (5,6,8,(10)(11)(12).…”

Cytomegalovirus gastritis: Clinicopathological profile

“…Patients were defined as "immunocompromised" if they were documented to have primary immunodeficiency, human immunodeficiency virus (HIV) infection, use of chemotherapeutic agent within 6 months, use of immunosuppressants (including corticosteroids [oral or intravenous administration, 20 mg/day of prednisolone or any equivalent for > 2 weeks]), or were the recipient of solid organ or bone marrow transplantation [8][9][10][11] .…”