Massive gastrointestinal bleeding in a patient with AIDS

Area of Science:

• Gastroenterology
• Infectious Diseases
• Virology

Background:

• Cytomegalovirus (CMV) enteritis is a known complication in patients with acquired immune deficiency syndrome (AIDS).
• Typically, CMV affects the colon, stomach, or terminal ileum, often diagnosable via standard endoscopic procedures.
• Gastrointestinal bleeding is a significant manifestation of CMV enteritis in immunocompromised individuals.

Observation:

• A case of massive lower gastrointestinal bleeding was reported in an AIDS patient.
• Conventional endoscopy and imaging failed to identify the bleeding source.
• The bleeding was attributed to a CMV infection localized to the proximal jejunum.

Findings:

• Enteroscopy during laparotomy revealed an ulcerated lesion in the jejunum.
• Histological examination confirmed the lesion as cytomegalovirus infection.
• The patient received ganciclovir and highly active antiretroviral therapy (HAART).

Implications:

• This case underscores the potential for CMV to affect unusual sites like the proximal jejunum, challenging standard diagnostic approaches.
• Enteroscopy can be crucial for diagnosing obscure gastrointestinal bleeding in immunocompromised patients.
• Prompt diagnosis and treatment, including antiviral therapy and HAART, can effectively manage CMV enteritis and prevent recurrent bleeding.