Cytomegalovirus-associated Toxic Megacolon in an Immunocompetent Host: Is It Really That Uncommon?

Cytomegalovirus (CMV) is a herpes virus that usually affects immunocompromised hosts. However, there has been a recent increase in CMV-associated infections in immunocompetent hosts, with the most common sites including the gastrointestinal tract, lungs, liver, and spleen. We present a case of a 60-year-old male patient who presented with abdominal pain and diarrhea with radiological findings including circumferential mural thickening in the rectum, rectosigmoid, and descending colon with loss of haustrations in the transverse colon suggestive of colitis with toxic megacolon. A subtotal colectomy was performed, which showed gross features of inflammatory bowel disease; however, histopathological findings were suggestive of CMV colitis with typical nuclear and cytoplasmic features. The patient succumbed to death within 2 weeks postsurgery. This case emphasizes the fact that an immunocompetent host present with dreaded complications of CMV colitis, especially older patients, hence elderly age being one of the vulnerable groups.