An Unusual Cause of Colitis in an Immunocompetent Patient

Abstract

Purpose: Cytomegalovirus (CMV) is a well-recognized pathogen, with 40-100% of general population having shown prior exposure. It usually occurs in immunodeficient individuals but can occasionally cause a self-limited colitis in the immunocompetent individual. Only anecdotal reports of CMV infections in immunocompetent individuals have been described in literature. Severe CMV infections can affect every system including the GI tract, CNS, and the arterial/venous systems. Manifestations and endoscopic findings of CMV infections can resemble other common conditions like IBD. Methods: Typically intranuclear and cytoplasmic inclusions are diagnostic of cytomegalovirus. Increased mortality is seen in patients ≥55 years of age, associated immune-modulating diseases and patients requiring colectomy. Young, healthy patients have a good prognosis. Results: A 72-year-old African American female with PMH of DM, HTN, Hyperlipidemia, CKD, CVA complains of abdominal pain and diarrhea for three days. Abdominal pain described as 10/10, diffuse, constant and crampy in nature without any radiation or aggravating or alleviating factors. Diarrhea is described as watery loose stool that occurs 5-6 times per day. Home meds include Norvasc, Hydralazine, Lisinopril, Novolin, Lasix, Lipitor, Aspirin. Physical exam is significant for tachycardia with a Heart rate of 105/mt and diffusely tender abdominal exam. Colonoscopy reveals diffuse, edematous circumferential ulceration of about 5-cm segmental region with adherent stool and random biopsies taken. Rectal Biopsy reveals acute and chronic inflammation and stain-positive for CMV colitis. HIV is negative. Conclusion: Although rare, physicians should maintain a high index of suspicion in the differential diagnosis of patients who have colitis even when no immunoincompetency exists.Figure: [1223]Figure: [1223]