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Severe ischemic cytomegalovirus proctocolitis with multiple perforation.

Reuban Toby D'cruz¹, Cheryl Chien-Li Lau², Thomas Paulraj Thamboo³

¹Department of Surgery, Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore. reuban.dcruz@gmail.com.

Archives of Virology

|March 14, 2018

Summary

Cytomegalovirus (CMV) can cause rare colonic perforations in older adults. This case highlights CMV gastrointestinal infection as a potential cause of severe bowel issues, mimicking other conditions.

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Area of Science:

Gastroenterology
Infectious Diseases
Colorectal Surgery

Background:

Cytomegalovirus (CMV) commonly causes gastrointestinal infections, but colonic perforations are exceptionally rare.
This case involves an 88-year-old male with severe abdominal symptoms.

Observation:

Patient presented with intractable abdominal discomfort, bloating, nausea, and diarrhea.
Flexible sigmoidoscopy showed significant ulceration with yellowish slough in the rectosigmoid area.
Emergency surgery revealed multiple perforations in the rectosigmoid junction.

Findings:

The colonic perforations were attributed to a Cytomegalovirus gastrointestinal infection.
The infection induced an ischemic process secondary to vasculitis, leading to perforation.
This CMV-induced vasculitis accelerated the pathway to colonic perforation.

Implications:

Cytomegalovirus gastrointestinal infection should be considered in the differential diagnosis for patients presenting with colonoscopy findings similar to ischemic colitis or Clostridium difficile infections.
Early recognition and consideration of CMV are crucial in managing complex gastrointestinal presentations, especially in elderly patients.
This case underscores the potential severity of CMV infections in the gastrointestinal tract, leading to surgical emergencies.