Roger Williams Medical Center Providence, RI, United States
Praneet Srisailam, MD Roger Williams Medical Center, Providence, RI
Introduction: Colitis by cytomegalovirus (CMV) infection is a common complication in immunosuppressed patients. Rarely, CMV may affect immunocompetent healthy individuals. However, CMV infection presenting as isolated inflammatory polyps is unusual.
Case Description/Methods: A 56 year old female with past medical history of ALL status post BMT 12 years ago currently in remission, adenomatous inflammatory colonic polyps 6 years ago found as a part of routine screening colonoscopy presented now with abdominal bloating, constipation for few weeks.Patient underwent colonoscopy as a part of diagnostic evaluation as well as screening for previously diagnosed adenomatous polyps. Patient's home medications include Acyclovir, Mycophenolate mofetil. Colonoscopy showed two 6-8mm polyps in the descending colon. one 4mm polyp in the rectum. Polyps were resected, specimens were sent to pathology. The intraluminal examination was otherwise normal on direct and retroflexion views.Pathology report of descending colon polyp showed Inflammatory polyp with CMV intranuclear and intracytoplasmic inclusions within stromal and endothelial cells.Hyaline sclerosis of vascular walls with infrequent scarring and luminal obliteration, likely related to chronic CMV endotheliitis.No evidence for amyloidosis.Pathology report of rectal polyp showed tubular adenoma with focal high grade dysplasia and thick walled blood vessels, suggesting chronic vasculitis and repair secondary to CMV infection.Patient was scheduled to have follow up for further work up including CMV IgG Ab, viral load.
Discussion: Infectious agents are one of the potential etiologies for the pathologic findings of the gastrointestinal specimens. Various clinical settings such as general debilitation, infancy or advanced age, immunocompromised state, hematologic malignancies, chemotherapy or diabetes predispose patients to viral infections of the GI tract. Endoscopic evaluation with biopsies are often performed as part of the diagnostic workup of such patients. Considering the site and the pattern of injury along with microscopic recognition of the viral inclusions are essential in identifying the possible cause of injury.This case highlights the endoscopic and histological appearance of gastrointestinal CMV infection. Awareness of these unusual lesions should enhance detection and proper classification of CMV presentation.The predictive model with typical endoscopic findings may be useful for detecting CMV infections.
Figure: Semi-pedunculated polyp in the descending colon(left)
Praneet Srisailam indicated no relevant financial relationships.
Praneet Srisailam, MD. P0213 - Chronic Cytomegalovirus Presented as Isolated Colonic Polyps, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.