Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3750
Peer-review started: October 9, 2014
First decision: October 29, 2014
Revised: November 15, 2014
Accepted: December 14, 2014
Article in press: December 16, 2014
Published online: March 28, 2015
Processing time: 172 Days and 15.7 Hours
We report a rare case of cytomegalovirus (CMV) colitis followed by severe ischemic colitis in a non-immunocompromised patient. An 86-year-old woman was admitted after experiencing episodes of vomiting and diarrhea. The next day, hematochezia was detected without abdominal pain. The initial diagnosis of ischemic colitis was based on colonoscopy and histological findings. The follow-up colonoscopy revealed a prolonged colitis. Immunohistochemical staining detected CMV-positive cells following conservative therapy. Intravenous ganciclovir therapy led to successful healing of ulcers and disappearance of CMV-positive cells. The prevalence of CMV infection is common in adults. CMV colitis is relatively common in immunocompromised patients; however, it is rare in immunocompetent patients. In our case, CMV infection was allowed to be established due to the disruption of the colonic mucosa by the prior severe ischemic colitis. Our experience suggests that biopsies may be necessary to detect CMV and the prompt management of CMV colitis should be instituted when intractable ischemic colitis is observed.
Core tip: Cytomegalovirus colitis is common in immunocompromised patients but rare in immunocompetent patients. In cases where ischemic colitis is prolonged, it is important to consider cytomegalovirus colitis. This case report not only represents the colonoscopy and pathological findings in immunocompetent patients, but also applies the method of diagnosing and treating immunocompetent patients.