Aurora St. Luke's Medical Center

Aurora Sinai Medical Center

Presentation Notes

Poster presented at 2018 APC Wisconsin Chapter Annual Scientific Meeting; September 7, 2018; Wisconsin Dells, WI.


Introduction: Cytomegalovirus (CMV) colitis is typically found in patients that are immunocompromised and is rarely found in immunocompetent patients. CMV ileitis has been primarily described in AIDS patients and is found in 4% of CMV cases affecting the GI tract. In this case, we present an immunocompetent patient who presented with a high grade small bowel obstruction (SBO) that was secondary to CMV ileocolitis causing a terminal ileum stricture. Case Description: A 60-year-old immunocompetent, HIV-negative black male presented with small bowel obstruction. CT scan of the abdomen showed circumferential wall thickening of the terminal ileum (TI). Colonoscopy was unrevealing due to incomplete bowel prep. He was deemed a poor candidate for surgery given severe cardiomyopathy. Outpatient colonoscopy was planned for after completion of two weeks of prednisone for presumed Crohn’s disease. The patient had persistent abdominal pain requiring readmission. Colonoscopy showed ulcerations and erosions in the TI and cecum with a TI stricture that could not be transversed. Biopsies were taken and showed crypt distortion and ulceration; immunohistochemical staining was positive for Cytomegalovirus (CMV). Patient underwent bowel resection, and gross specimen further confirmed viral cytopathic change with multiple superficial ulcerations and vasculature containing endothelial cells with prominent viral inclusions positive for CMV. Discussion: CMV ileitis is rare in immunocompetent patients. A systematic review of immunocompetent patients with CMV in any system in 2008 described 60 patients with CMV colitis. There is only one other case report of a patient with a CMV –induced colonic stricture presenting as an acute intestinal obstruction in an immunocompetent adult. This is the only case of CMV terminal ileocolitis with primary ileal involvement that caused acute intestinal obstruction in an immunocompetent adult.

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