A Rare Presentation of Cytomegalovirus (CMV) Colitis as a Colonic Mass

Document Type

Conference Proceeding

Publication Date

10-1-2024

Publication Title

Am J Gastroenterol

Abstract

Introduction: Cytomegalovirus (CMV) infection affects the gastrointestinal tract in both immunocompromised and immunocompetent individuals. While commonly manifesting as ulcerative lesions, instances of CMV-induced mass lesions in the gastrointestinal tract are rare, and have only been described in a handful of cases. We herein report a rare presentation of CMV as a discrete colonic mass in a patient presenting with hematochezia. Case Description/Methods: A 54-year-old woman with end state renal disease on hemodialysis, hypertension, and sarcoidosis (on azathioprine), presented to the emergency roomwith rectal bleeding ongoing for a few months.A month prior she was hospitalized for diarrhea and abdominal pain. Abdominal computed tomography at the time was concerning for ischemic vs infectious colitis. She was scheduled for an outpatient colonoscopy. In the emergency room, the patient was hypotensive, and her hemoglobin dropped from 8.4 g/dl to 6.5 g/dl. She had a normal white blood cells and CD4 T-cell count. Computed tomography showed colitis from the cecum to the distal transverse colon. Stool studies ruled out C. difficile/common bacterial infections. She underwent a colonoscopy which showed 3 x 4 cm protruding mass in the ascending colon contiguous with the ileocecal valve. The lesion was villous and characterized by superficial ulceration, friability, and scarring, with an adjacent area of ulceration and erythema on a nearby colonic fold (Figure 1). Biopsies revealed severely active nonspecific colitis in the ascending and transverse colon with positive CMV staining. The patient was started on ganciclovir IV 1.25 mg/kg 3 times weekly (renal dose adjusted) for 3 weeks. On follow up 3 weeks later, her other symptoms resolved and CMV levels were undetected. She still complained of abdominal pain, so the decision was to continue Valganciclovir for 6 weeks with regular monitoring. Follow up 2 months later showed hemoglobin improvement to 11.4 g/dl, with resolution of all symptoms. Discussion: While colonic masses are commonly attributed to neoplasms, infectious causes like CMV must be considered. Gastrointestinal symptoms of CMV when present are usually in patients with low white blood cell and CD4 counts, with HIV/AIDS or transplantation being the 2 greatest risk factors, but suspicion should be considered in individuals on immunosuppressants for rheumatological conditions as well, even with normal counts. Identification of CMV warrants medical intervention, resulting in clinical improvement and potential resolution of the mass.

Volume

119

Issue

10

First Page

S1995

Find It @ Sladen

Share

COinS