3067 Colon Mass From an Unusual Etiology

Abstract

INTRODUCTION: There is a high level of suspicion for colon cancer in an adult patient with hematochezia and endoscopic evidence of a mass. However, it is important to biopsy the mass for definitive diagnosis as other etiologies may be responsible. This case reports on the surprising finding of an ulcerated colon mass found to be due to CMV infection. CASE DESCRIPTION/METHODS: A 71-year-old female with past medical history significant for end stage renal disease, hypertension, diabetes mellitus type 2, atrial fibrillation, and peripheral vascular disease was admitted for chest pain and generalized weakness. Gastroenterology was consulted after the patient complained of rectal bleeding in the setting of anemia. A colonoscopy was performed, which showed an ulcerated-appearing 5 × 4 cm mass extending into the ileocecal valve with biopsies taken with concern for malignancy. However, the biopsies showed evidence of a sessile-serrated adenoma that was negative for malignancy and positive for CMV. Ganciclovir was started for treatment of the CMV, and a colonoscopy was scheduled to be done after completion of the antiviral course. DISCUSSION: CMV is a member of the Herpesviridae family and has a high prevalence, with 50-80% of adults in the United States being seropositive at 40 years of age or older. It often reactivates in people who are immunosuppressed, with the GI tract being a common area for reactivation. CMV in the colon has a variable presentation, though it usually presents with signs of colitis. Definitive diagnosis of CMV requires biopsy. Treatment is with antiviral medications, such as ganciclovir. This case shows that while a colonic mass in an adult patient presenting with hematochezia places colon cancer high in the differential diagnosis, it is important to consider other etiologies.