Cytomegalovirus Colitis and Pancreatitis in an AIDS Patient

Abstract

Purpose: To describe a case of cytomegalovirus induced colitis, complicated by gastrointestinal bleeding and pancreatitis in a patient with AIDS. Methods: Cytomegalovirus is a member of the herpesviridae subfamily. Results: A 51 year old male recently diagnosed with AIDS presents with 3 week history of bloody diarrhea, vomitting, chills and abdominal pain. He was not on any medications for HIV at this time. His abdomen was soft, diffusely tender with diminished bowel sounds. CBC revealed a Hgb of 8% and serum lipase was 806. His CD4 count was 35. An abdominopelvic CT showed increased size of pancreas with peripancreatic fat stranding. Patient was placed on NPO and fluid resuscitation. Stool for C. difficile, ova and parasite came back negative. Three days later he had several episodes of hematochezia and continued with abdominal pain. Patient was transfused with 2 units of PRBC and colonoscopy followed by an EGD was done. Colonoscopy revealed congested mucosa and frank blood in the Sigmoid, descending, transverse and ascending colon. EGD showed blood in the duodenum. Biopsy findings include a positive CMV immunostain, chronic colitis and focal ulcerations in the ascending colon, ileocaecal valve and rectum. Duodenal biopsy was also positive for CMV immunostain and revealed extensive duodenal ulcerations. He was started on Valgancyclovir for CMV infection. Patients abdominal pain and hematochezia resolved. Patient went home on Valgancyclovir and has been stable since discharge. Conclusion: In AIDS patients with gastrointestinal manifestations, opportunistic infections like cytomegalovirus should be part of the differential.