Severe ischemic cytomegalovirus proctocolitis with multiple perforation

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.