BACKGROUND Cytomegalovirus (CMV) enterocolitis presenting in the form of pancolitis or relating to the little and huge intestines within an immunocompetent individual is rarely encountered, and CMV enterocolitis presenting with a significant problem, such as for example toxic megacolon, within an immunocompetent adult offers just been reported on the few events
November 2, 2020
BACKGROUND Cytomegalovirus (CMV) enterocolitis presenting in the form of pancolitis or relating to the little and huge intestines within an immunocompetent individual is rarely encountered, and CMV enterocolitis presenting with a significant problem, such as for example toxic megacolon, within an immunocompetent adult offers just been reported on the few events. biopsy. Even though the analysis of CMV enterocolitis was postponed, the individual was treated by repeat colonoscopic decompression and antiviral therapy with intravenous ganciclovir successfully. CONCLUSION This record cautions that CMV-induced colitis is highly recommended just as one differential analysis in an individual with intractable symptoms of enterocolitis or megacolon of unknown cause, even when the patient is usually non-immunocompromised. Keywords: Toxic megacolon, Cytomegalovirus, Enterocolitis, Immunocompetent, Case report Core tip: Cytomegalovirus (CMV) enterocolitis presenting as toxic megacolon in an immunocompetent patient is rarely encountered. We report the case of a 70-year-old male with a non-immunocompromised state that presented PC786 with toxic megacolon and subsequently developed massive hemorrhage as a complication of CMV ileo-pancolitis. Although the diagnosis was delayed until massive hematochezia developed, the patient was treated successfully by repeat colonoscopic decompression and intravenous ganciclovir. A high degree of clinical suspicion is required to diagnose CMV enterocolitis, especially in immunocompetent patients, and this condition should be considered as a possible differential diagnosis in patients with intractable symptoms of enterocolitis or megacolon of unknown cause. INTRODUCTION Cytomegalovirus (CMV) is usually a highly prevalent virus with a worldwide distribution, and CMV infections in healthy adults are usually asymptomatic or cause a mildly infectious mononucleosis-like syndrome. CMV then usually becomes dormant until reactivation in PC786 patients with a severely immunocompromised status, and could manifest as intrusive CMV disease with an array of manifestations, most colorectal infection with hemorrhagic ulceration frequently. However, gastrointestinal participation with CMV infections is unusual in immunocompetent people. CMV colitis could be challenging by substantial hemorrhage, severe colonic pseudo-obstruction, poisonous megacolon, and perforation. Nevertheless, CMV colitis provides often been skipped by scientific doctors in immunocompetent sufferers delivering with these significant problems. Furthermore, CMV colitis delivering as megacolon within an immunocompetent adult has rarely been reported. Here we report on a case of CMV ileo-pancolitis presenting as toxic megacolon and subsequent massive hemorrhage in an immunocompetent patient. This case highlights that this PC786 condition should be considered as a possible differential diagnosis in even non-immune compromised patients with megacolon or intestinal pseudo-obstruction of unknown cause. CASE PRESENTATION Chief complaints Abdominal pain and constipation. History of present illness A 70-year-old man was referred to our hospital due to generalized abdominal pain and reduced stool passage over the previous 2 wk. He reported no melena or body weight loss. History of past illness He had no history of abdominal surgery and no notable medical history. Personal and family history He had no specific personal or family history. Physical examination upon admission The patients heat was 38.4 C. His physical examination revealed a distended stomach with tenderness and hypoactive bowel sounds. Laboratory examinations Laboratory tests upon admission uncovered; low hemoglobin (11.2 g/dL; regular, 13-17 g/dL), neutrophilic leukocytosis (white bloodstream cell, 12200 cells/mL; regular, 3900-10600 cells/mL; neutrophils 88.7%), high C-reactive proteins (CRP; 29.1 mg/dL; regular, < 0.5 mg/dL), high erythrocyte sedimentation price (101 mm/h; regular, < 20 mm/h), and negativity for anti-nuclear antibody, individual immunodeficiency virus. Various other laboratory results included regular renal, thyroid and hepatic function, and regular electrolyte results. Feces civilizations for Clostridium difficile and enteric bloodstream and pathogens civilizations were all harmful. Imaging examinations Abdominal computed tomography (CT) and X-ray imaging demonstrated proclaimed diffuse dilatation from the ileum and whole digestive tract but no particular obstructive lesion (Body ?(Figure1).1). Least digestive tract size was 7 cm, that was in keeping with a medical diagnosis of megacolon. Open up in another window Body 1 An X-ray picture of the abdominal. Abdominal film displaying proclaimed distensions of loops from the huge and TCF3 small intestines. Colonoscopic and further diagnostic work-up on clinical time course Sigmoidoscopy revealed diffuse ulcerative and hyperemic mucosa with friability and edema, and a large amount of fecal matter, which avoided visualization from the digestive tract wall. Endoscopic biopsy specimens indicated just severe and persistent irritation, erosion, and necrotic debris. Based on the initial laboratory, radiologic and endoscopic findings, ciprofloxacin and metronidazole antibiotic therapy with supportive care including nil-per-os, total parenteral nutrition, nasogastric decompression, and correction of fluid and electrolyte abnormalities was started under a provisional diagnosis of severe acute enterocolitis with harmful megacolon of unknown cause. Although the patient remained febrile with abdominal distension despite antibiotic treatment and two additional repeated colonoscopic decompressions, we postponed the surgical option and continued supportive treatment because clinical signs and symptoms did not worsen. On hospital day 7, he began passing approximately 1 liter of new blood per rectum and hemoglobin fell from 11.0 g/dL to 7.1 g/dL, which required aggressive packed reddish blood cell transfusion, fluid resuscitation, and intravenous vasopressors and inotropes to maintain hemodynamic stability. After.