A0114 - A Common Infection in a Highly Atypical Patient: Hematochezia From Cytomegalovirus Colonic Ulcer in a Young and Healthy Immunocompetent Patient

Nouf Turki, MD¹, Taylor Brewer, ¹, Bedoor Alabbas, MD², Leen Raddaoui, MD³, Marie L. Borum, MD, EdD, MPH⁴, Samuel A. Schueler, MD⁴, Mamoun Younes, MD^2
1George Washington University Hospital, Washington, DC; ²George Washington University Hospital, Washington, VA; ³The George Washington University School of Medicine and Health Sciences, Washington, DC; ⁴George Washington University, Washington, DC

Introduction: Gastrointestinal (GI) cytomegalovirus (CMV) infections are far more common in immunocompromised as opposed to immunocompetent patients. Immunocompetent patients who do develop GI tract CMV infections are typically older with medical comorbidities. As such, descriptions of GI CMV infections in younger immunocompetent patients are lacking. Here we present a case of a GI CMV infection in a young and healthy immunocompetent patient.

Case Description/Methods: A 41-year-old male with hyperlipidemia and hypothyroidism presented with painless, intermittent hematochezia. He denied changes in bowel habits or appetite, abdominal pain, fevers, chills, fatigue, or weight loss. History was pertinent for insertive and receptive intercourse with one male partner. Medications were emtricitabine/tenofovir for pre-exposure prophylaxis, levothyroxine, and atorvastatin. Colonoscopy revealed a cecal ulcer surrounded by nodular-appearing mucosa that felt firm and was friable when biopsied (Figure 1). The remaining colon and terminal ileum were normal. There was no diverticulosis or hemorrhoids. Pathology was positive for CMV (Figure 2). Subsequent serological evaluation revealed normal complete blood count and comprehensive metabolic panel. Tests for human immunodeficiency virus, syphilis, viral hepatitis, chlamydia and gonorrhea were negative. He was treated with Valganciclovir 900 milligrams twice daily for 21 days. A subsequent test for CMV deoxyribonucleic acid polymerase chain was negative. Hematochezia resolved. Repeat colonoscopy revealed normal mucosa in the cecum.

Discussion: GI CMV infections in immunocompetent patients are rare and typically occur in older patients with medical comorbidities. One study identified 56 immunocompetent patients with GI CMV infections (mean age of 73 years) that had a higher 6-month mortality rate (39.2%) than 117 immunocompromised patients with CMV GI infections (21.9%), highlighting the significant comorbidities in the immunocompetent group. Another study of 13 immunocompetent patients with GI CMV infections (median age 81 years) found 54% had immune-modulating conditions (i.e. diabetes, liver or renal failure). A third study of 89 immunocompetent patients with GI CMV infections (median age 70 years) showed a majority had significant comorbidities. Further such case reports are needed to inform clinicians about risk factors and presentation of GI CMV infections in young healthy immunocompetent patients.



Disclosures:


Nouf Turki, MD¹, Taylor Brewer, ¹, Bedoor Alabbas, MD², Leen Raddaoui, MD³, Marie L. Borum, MD, EdD, MPH⁴, Samuel A. Schueler, MD⁴, Mamoun Younes, MD². A0114 - A Common Infection in a Highly Atypical Patient: Hematochezia From Cytomegalovirus Colonic Ulcer in a Young and Healthy Immunocompetent Patient, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.