Cytomegalovirus hemorrhagic colitis in a nontransplant patient

A 75-year-old man with major colonic hemorrhage was found at exploratory laparotomy and colectomy to have acute sigmoid colitis induced by cytomegalovirus (CMV) infection. The usual risk factors for CMV colitis (previous mucosal injury, cytotoxic drug therapy, and transplantation) were absent. The stress and debility of an acute uremic state and a long hospital stay may have compromised the patient's immune system and allowed for viral invasion of the colon. This manifestation of cytomegalic disease is an extremely unusual but important clinical entity. Accurate and prompt diagnosis, which requires a high index of suspicion, is important, since in the majority of cases, colectomy is indicated for control of hemorrhage.