CYTOMEGALOVIRAL ENTERITIS: A RARE CAUSE OF SMALL GUT PERFORATION

Maqbool Ahmed, Sohail Saqib, Mannan Masud, Aurangzeb Aurangzeb, Abeerah Pervez, Zainab Kamal, Raheel Khan

Abstract


A 47-year-old man was admitted with four months history of pain upper central abdomen associated
with passage of 3–4 loose watery stools per day. Abdominal examination revealed soft abdomen with
mild tenderness in the para-umbilical region. There was associated hepatomegaly. His Hb% was low,
liver and renal functions were deranged. Upper GI endoscopy revealed antral ulcer, and colonoscopy
revealed a caecal ulcer, which were biopsied. Liver biopsy was also done. Histopathology report showed
evidence of inflammatory colitis and chronic hepatitis, so a diagnosis of inflammatory bowel disease
with autoimmune hepatitis was made. He was negative for HIV and hepatitis serology. He was given
long list of medicine including steroids but the symptoms did not improve. Two months after admission
he developed severe abdominal pain associated with distension. The X-Ray chest revealed
pneumoperitoneum and laparotomy was carried out which revealed a small perforation in terminal ileum
associated with multiple circular indurated areas ranging from few mm to 1.5 Cm in size with central
thinning spread over distal half of small gut and enlarged mesenteric lymph nodes. The biopsy of
perforated area revealed cytomegaloviral enteritis. Postoperatively patient developed ARDS and died on
13th postoperative day.
Keywords: Cytomegalovirus, CMV, Perforation, ileal

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