Massive lower gastrointestinal hemorrhage caused by CMV disease as a presentation of HIV in an infant

Abstract

The gastrointestinal (GI) manifestations of acquired immunodeficiency syndrome in children are related to opportunistic infections like cytomegalovirus (CMV). CMV disease of the GI tract is a major cause of morbidity and mortality in immunocompromised patients: it typically produces mucosal ulcerations that can result in pain, bleeding, diarrhea, and GI perforation, often around the cecum. Preoperative diagnosis may be difficult, plain films and barium enema are often non-specific, and endoscopic evaluation is impossible when there is massive bleeding. The patient usually needs surgery to establish the correct diagnosis and initiate appropriate treatment. The use of gancyclovir for CMV disease in the postoperative period has improved the prognosis.

Gastrointestinal Complications of Secondary Immunodeficiency Syndromes

“…Children may be systemically ill. 53 The colitis from CMV infection is patchy in nature and can be associated with severe necrotizing colitis and hemorrhage. 54 CMV usually affects the cecum and the right colon. Diagnosis is confirmed by endoscopy and biopsy.…”