CYTOMEGALOVIRAL ENTERITIS: A RARE CAUSE OF SMALL GUT PERFORATION
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, ilealReferences
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.
