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

Abstract

A 37-year-old woman with a history of inflammatory bowel disease on mercaptopurine presented with a week of recurrent fever, headache, myalgias and mildly elevated serum transaminases and leucopenia. Her workup revealed primary cytomegalovirus (CMV) infection with atypical lymphocytosis, elevated viral load, positive IgM and negative IgG. Two weeks after her initial presentation, she developed odynophagia and diarrhoea prompting endoscopic evaluation with biopsies, which demonstrated CMV disease of the gastrointestinal tract. Her fever and systemic symptoms improved rapidly with initiation of intravenous ganciclovir. She was transitioned to and maintained on oral valganciclovir until two and half months after discharge when her symptoms and lab abnormalities had fully subsided.

Cytomegalovirus-Associated Nephrotic Syndrome in a Patient with Myasthenia Gravis Treated with Azathioprine: A Case Report

“…Furthermore, CMV infection can present in various ways. Besides CMV pneumonitis, several case reports showed that immunosuppressive therapy might have a role in development of CMV retinitis [ 13 , 14 ], as well as thrombocytopenia [ 15 ], myalgia [ 16 ], arthralgia [ 17 , 18 ], hepatitis [ 19 ], pericarditis [ 20 ], or gastrointestinal [ 8 , 10 ] and neurological disorders [ 19 , 21 ], and even oral ulcers [ 22 , 23 ]. In some rare cases, CMV infection also presents as nephrotic syndrome.…”