CYTOMEGALOVIRAL ENTERITIS: A RARE CAUSE OF SMALL GUT PERFORATION

Authors

  • 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 associatedwith passage of 3–4 loose watery stools per day. Abdominal examination revealed soft abdomen withmild 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 colonoscopyrevealed a caecal ulcer, which were biopsied. Liver biopsy was also done. Histopathology report showedevidence of inflammatory colitis and chronic hepatitis, so a diagnosis of inflammatory bowel diseasewith autoimmune hepatitis was made. He was negative for HIV and hepatitis serology. He was givenlong list of medicine including steroids but the symptoms did not improve. Two months after admissionhe developed severe abdominal pain associated with distension. The X-Ray chest revealedpneumoperitoneum and laparotomy was carried out which revealed a small perforation in terminal ileumassociated with multiple circular indurated areas ranging from few mm to 1.5 Cm in size with centralthinning spread over distal half of small gut and enlarged mesenteric lymph nodes. The biopsy ofperforated area revealed cytomegaloviral enteritis. Postoperatively patient developed ARDS and died on13th postoperative day.Keywords: Cytomegalovirus, CMV, Perforation, ileal

References

Jacobson MA, Mills J. Serious cytomegalovirus disease in the

acquired immune deficiency syndrome. Ann Int med

;108:585–94.

Eyre-Brook IA, Dundas S. Incidence and clinical significance of

colonic cytomegalovirus infection in idiopathic inflammatory

bowel disease requiring colectomy. Gut 1986;27:1419–25.

Krech U. Complement-fixing antibodies against cytomegalovirus

in different parts of the world. Bull World Health Organ

;49:103–6.

Weber R, Ledergerber B, Zbinden R, Altwegg M, Pfyffer GE,

Spycher MA, et al. Enteric infections and diarrhea in human

immunodeficiency virus-infected persons: Prospective

community-based cohort study. Swiss HIV Cohort Study. Arch

Intern Med 1999;159:1473–80.

Dolgin SE, Larsen JG, Shah KD, David E. CMV enteritis

causing hemorrhage and obstruction in an infant with AIDS. J

Pediatr Surg 1990;25:696–8.

Lai IR, Chen KM, Shun CT, Chen MY. Cytomegalovirus

enteritis causing massive bleeding in a patient with AIDS.

Hepatogastroenterology 1996;43:987–91.

Chamberlain, RS, Atkins, S, Saini, N, White, JC. Ileal perforation

caused by cytomegalovirus infection in a critically ill adult. J Clin

Gastroenterol 2000;30:432.

Dieterich DT, Poles MA, Lew EA, Martin-Munley S, Johnson

J, Nix D, et al. Treatment of gastrointestinal cytomegalovirus

infection with twice-daily foscarnet: a pilot study of safety,

efficacy, and pharmacokinetics in patients with AIDS.

Antimicrob Agents Chemother 1997;41(6):1226–30.

Nelson, MR, Connolly, GM, Hawkins, DA, Gazzard, BG.

Foscarnet in the treatment of cytomegalovirus infection of the

esophagus and colon in patients with the acquired immune

deficiency syndrome. Am J Gastroenterol 1991;86:876.

Wani RA, Parray FQ, Bhat NA, Wani MA, Bhat TH, Farzana F.

Nontraumatic terminal ileal perforation. World J Emerg Surg

;1:7.

Stoner MC, Forsythe R, Mills AS, Ivatury RR, Broderick TJ.

Intestinal perforation secondary to Salmonella typhi: case report

and review of the literature. Am Surg 2000;66:219–22.

Published

2011-12-01

Issue

Vol. 23 No. 4 (2011): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

CASE REPORT

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.