Cytomegalovirus colitis with a new diagnosis of ulcerative colitis in an elderly woman.
J Rural Med 2022;
17:85-88. [PMID:
35432635 PMCID:
PMC8984622 DOI:
10.2185/jrm.2021-053]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/12/2021] [Indexed: 12/03/2022] Open
Abstract
Objectives: Cytomegalovirus (CMV) colitis is generally diagnosed in
immunocompromised patients. It is rare for patients who are not immunocompromised to
develop CMV colitis. Cases of CMV colitis in patients with inflammatory bowel disease have
also been reported. We encountered a case of CMV colitis with a new diagnosis of severe
ulcerative colitis and demonstrated the importance of suspecting ulcerative colitis in
immunocompetent patients with CMV colitis.
Patient: A 78-year-old woman was hospitalized with fever and diarrhea that
had lasted for a month. Colonoscopy revealed continuous diffuse edema, mucosal redness,
and multiple punched-out ulcers with bleeding, suggesting cytomegalovirus (CMV) colitis,
although she was not immunocompromised. Immunohistochemical staining revealed CMV-positive
cells, and CMV colitis was diagnosed. One month later, a colonoscopy was conducted owing
to persistent symptoms despite initiating the prescribed antiviral drug. A complete loss
of vascular pattern, easy bleeding of the crude mucosa, and exacerbation of multiple
punched-out ulcers were observed. She was diagnosed with severe ulcerative colitis. The
symptoms of ulcerative colitis disappeared with prednisolone and 5-amino salicylic acid
treatment.
Conclusion: Ulcerative colitis should be suspected in immunocompetent
patients with CMV colitis.
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