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


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


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