Cytomegalovirus colitis in immunocompetent patients: a clinical and endoscopic study

Cytomegalovirus (CMV) colitis occurs rarely in immunocompetent patients and little detail is known about the clinical features, endoscopic findings and prognosis of CMV colitis in immunocompetent patients. The aim of this study was to investigate the clinical and endoscopic features of CMV colitis and its prognosis in immunocompetent patients.

We retrospectively reviewed the medical records and the endoscopic findings of twelve immunocompetent patients who were diagnosed with CMV colitis by immunostaining for CMV antibodies based on the histological examination of tissue biopsies obtained during colonoscopy. The patients were six men and six women and their median age was 66 years (range 44-88).

Patients infected with CMV colitis had comorbidities including diabetes mellitus (n=4), chronic renal failure (n=3) and ischemic heart disease (n=2). The most common initial presenting symptom was gastrointestinal bleeding (n=7) and the associated symptoms were diarrhea and abdominal pain. Endoscopic examination showed three types: well-demarcated ulcerative type (n=6), ulceroinfiltrative type (n=3), and pseudomembranous colitis-associated type (n=3). All patients were treated with an antiviral agent (ganciclovir) within two weeks following onset of main presenting symptom and all showed clinical and endoscopic improvement except one died later from severe pneumonia.

CMV colitis in immunocompetent patients presented in older patients and in those with other comorbidities. Gastrointestinal bleeding was the most common initial presentation. Despite aggressive clinical manifestations, the prognosis of CMV colitis is good if diagnosed and treated early.