Published online Oct 16, 2013. doi: 10.12998/wjcc.v1.i7.220
Revised: August 15, 2013
Accepted: August 20, 2013
Published online: October 16, 2013
Processing time: 93 Days and 11.5 Hours
Cytomegalovirus (CMV) infection of the gastrointestinal tract has been reported most frequently in the setting of immunodeficiency. The whole gastrointestinal tract can be affected; however, the small bowel is rarely affected. We report a case of CMV enteritis with jejunal perforation in a 53-year-old woman with a history of chemoradiation therapy for endometrial cancer 8 years previously. At follow-up evaluation, lower abdominal pain, diarrhea and vomiting appeared. Abdominal computed tomography showed intra-abdominal free air in the subphrenic space and porta hepatis. The jejunal segment revealed serosal purulent exudates with a perforation. The resected jejunal segment showed a large geographic ulcerative mucosal lesion. The microscopic findings revealed a diffuse ulcerative mucosal change with a prominent granulation tissue formation and many large atypical vascular endothelial cells and stromal fibroblasts with intranuclear or intracytoplasmic inclusion bodies. These cells were positive for CMV antibody. The final diagnosis was CMV-associated jejunitis with a jejunal perforation.
Core tip: Small bowel involvement with gastrointestinal cytomegalovirus (CMV) infection is very rare. However, CMV enteritis should be included in the differential diagnosis of the ulcerative lesion of a small bowel segment when abdominal pain, vomiting, diarrhea and perforation develop in patients with a history of cancer.