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Toxic megacolon caused by cytomegalovirus colitis in a multiply injured patient
A Machens1, C Bloechle, E G Achilles
1Department of General Surgery, University Hospital Eppendoft, University of Hamburg, Germany.
Abstract:
Cytomegalovirus (CMV) colitis is a rare event that has been described mainly in immunocompromised patients with immunosuppressive medication or HIV infection. An association with severe trauma has not been described previously. We report a formerly healthy, multiply injured 75-year-old male who subsequently developed what appeared to be pseudomembranous colitis. By the time the diagnosis of toxic megacolon on the basis of CMV colitis was established, he had succumbed to multiple organ failure. Whenever pseudomembranous colitis is clinically suspected but not confirmed in a critically ill formerly healthy patient, CMV colitis should be excluded. Once the diagnosis is confirmed, generous resection of all affected colon is mandatory in view of the limited benefit of antiviral therapy in CMV-induced toxic megacolon.
Insights
Cytomegalovirus (CMV) colitis, a rare condition, can occur in previously healthy patients after severe trauma. Early exclusion of CMV colitis is crucial in critically ill patients with suspected pseudomembranous colitis.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Trauma Surgery
Background:
- Cytomegalovirus (CMV) colitis is typically observed in immunocompromised individuals, such as those with HIV or on immunosuppressive therapy.
- Its association with severe trauma in previously healthy patients has not been previously documented.
Observation:
- A case report of a 75-year-old male with multiple injuries who developed pseudomembranous colitis.
- The patient ultimately succumbed to multiple organ failure before CMV colitis and toxic megacolon diagnosis.
Findings:
- Cytomegalovirus (CMV) colitis can manifest as pseudomembranous colitis and lead to toxic megacolon.
- Diagnosis was confirmed post-mortem in this critically ill trauma patient.
Implications:
- CMV colitis should be considered in the differential diagnosis of critically ill trauma patients presenting with suspected pseudomembranous colitis.
- Prompt diagnosis and surgical intervention, including extensive colon resection, are vital due to limited efficacy of antiviral therapy in severe cases.