Cytomegalovirus enterocolitis complicated by perforated appendicitis in a premature infant

Area of Science:

• Pediatric Gastroenterology
• Infectious Diseases
• Neonatal Medicine

Background:

• Cytomegalovirus (CMV) is a common virus that can cause serious illness in infants, particularly premature neonates.
• Gastrointestinal symptoms like enterocolitis and appendicitis are common in infants and have various etiologies.
• Early diagnosis and management of CMV in infants are crucial for preventing long-term complications.

Observation:

• A 9-week-old premature infant presented with recurrent abdominal distention and symptoms suggestive of appendicitis.
• Surgical exploration revealed ileocecal inflammation, stenosis, and a perforated appendix with cecal fistulization.
• Microscopic examination of resected tissue showed viral inclusions, with positive immunoperoxidase staining for CMV.

Findings:

• Cytomegalovirus (CMV) was identified as the causative agent of the infant's enterocolitis and appendicitis.
• The findings indicate a direct link between CMV infection and severe gastrointestinal pathology in this neonate.
• Intranuclear and intracytoplasmic viral inclusions confirmed CMV presence in the inflamed intestinal tissue.

Implications:

• Cytomegalovirus (CMV) should be considered in the differential diagnosis of enterocolitis and appendicitis in infants, especially premature ones.
• Failure to identify CMV as the etiology can lead to delayed treatment and potentially worse outcomes.
• This case underscores the importance of including CMV in the diagnostic workup for unexplained chronic gastrointestinal symptoms in neonates.