Baystate Medical Center Springfield, MA, United States
Fatima Warraich, MD, MEHP1, Bushra Zia, MD1, Yesenia Greeff, MD2 1Baystate Medical Center, Springfield, MA; 2University of Massachusetts Medical School - Baystate, Springfield, MA
Introduction: Cytomegalovirus (CMV) causes infection in immunocompromised patients. CMV colitis presents with hematochezia, abdominal pain, fever or diarrhea, and as perforation if severe. In the immunocompetent patient the infection is subclinical and self-limited. Here we present a case of an immunocompetent patient who presents with hematochezia, found to have CMV proctitis.
Objectives: Identify the typical clinical manifestations of CMV colitis Review the risk factors that can subject healthy subjects to CMV infection
Case Description/Methods: 83-year-old lady with Non-ST elevation myocardial infarction and type 2 diabetes who presented to hospital for episodes of bright red blood per rectum (BRBPR) shortly after being discharged after coronary artery bypass graft surgery.
The BRBPR was not associated with abdominal pain, rectal pain, melena, or fevers. She reported some preceding diarrhea that started after receiving bowel regimen for constipation. On evaluation, patient was stable with stable hemoglobin. CT angiography was obtained that showed circumferential wall thickening of the distal rectum, inflammatory change and presacral edema, consistent with proctitis with mucosal enhancement likely representing the bleed.
Sigmoidoscopy was arranged. Endoscopic findings included multiple, punched-out, irregular, non-bleeding rectal ulcers, measuring 2-6 cm. These were felt to be stercoral ulcers given history of constipation and no other risk factor for colon ischemia or infectious ulcers. Biopsies were obtained. Patient was discharged.
Histopathology returned positive for CMV proctitis. Patient was re-admitted and started on IV ganciclovir. She was evaluated by Infectious Disease and discharged on oral valganciclovir for a total of 21 days.
Discussion: As mentioned, CMV proctitis in an immunocompetent patient is rare. There are few documented sporadic cases in healthy patients (such as our patient), in literature. A case-control study was performed by Ko JH et al in 2015 to identify risk factors for CMV colitis in immunocompetent hosts. These risk factors included hemodialysis, rheumatic disease, patients in the intensive care unit, or those exposed to antibiotics, steroids, or red blood cell transfusion within one month of diagnosis of colitis. The 30-day mortality rate was reported as 7.8% in this study. A high degree of suspicion with early diagnosis through biopsy and pathologic studies; and early initiation of treatment with ganciclovir can lead to significant improvement in morbidity and mortality.
Fatima Warraich indicated no relevant financial relationships.
Bushra Zia indicated no relevant financial relationships.
Yesenia Greeff indicated no relevant financial relationships.
Fatima Warraich, MD, MEHP1, Bushra Zia, MD1, Yesenia Greeff, MD2. P2305 - Sporadic Infectious Proctitis From Cytomegalovirus in an Immunocompetent Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.