Cytomegalovirus (CMV) Colitis Complicated by a Stricture in an Immunocompetent Adult

Although cytomegalovirus (CMV) seropositivity is common in the general population, primary CMV infection in immunocompetent adults is usually asymptomatic or causes only a mild mononucleosis-like illness, and severe symptomatic or tissue-invasive disease is uncommon. CMV colitis may present with nonspecific symptoms, delaying recognition, particularly in immunocompetent patients in whom clinical suspicion is often low. Delayed diagnosis may allow progression to serious complications, including gastrointestinal bleeding, perforation, toxic megacolon, and, less commonly, stricture formation. We report a case of CMV colitis in an immunocompetent woman presenting with a colonic stricture initially presumed to be malignant rather than with the more typical features of abdominal pain, diarrhea, fever, and hematochezia. This case emphasizes the diagnostic challenge of CMV colitis in patients without classic risk factors, particularly when it mimics colonic malignancy and requires tissue diagnosis because noninvasive testing may not reliably exclude disease.