Cytomegalovirus Colitis in an Immunocompetent Patient: Report of a Case and Review of the Literature

Abstract

Most cases of cytomegalovirus (CMV) colitis occur in immunocompromised patients, including those with congenital or acquired immunodeficiency disease, those receiving immunosuppressive drugs, and transplant patients. Only a small number of immunocompetent patients with CMV colitis have been reported worldwide. We describe the first case reported in Taiwan. This 86-year-old man was initially treated for presumed ischemic colitis after a series of laboratory and image studies. Fever and abdominal pain persisted despite empirical treatment with antibiotics. Left hemicolectomy was performed one month after admission. Inclusion bodies characteristic of CMV infection were identified in surgical specimens. The patient recovered after the operation. We review the medical literature on the clinical features, diagnosis, prognosis, and treatment of CMV colitis in immunocompetent patients. Surgery is the choice of therapy for patients with colonic perforation, persistent gastrointestinal bleeding, toxic megacolon, or any other severe complication. We suggest that repeat biopsies be performed on any patient with a highly suspected case of CMVcolitis, and that antiviral therapy may not be necessary after surgical treatment in selected immunocompetent patients with underlying CMV infection.