Failure to Recognize the Diagnosis of Cytomegalovirus Colitis in an Immunocompetent Male: Need for Heightened Index of Suspicion

Abstract

Background: Cytomegalovirus (CMV) disease affects mainly immunosuppressed individuals such as stem cell and solid organ transplant recipients as well as those patients infected with the human immunodeficiency virus (HIV). Cytomegalovirus colitis has been diagnosed increasingly in normal hosts. Case Presentation: A 65-year-old male with a history of alcohol abuse had been hospitalized for severe bloody diarrhea for three months in an outside hospital; he tested negative for clostridial toxin. He was transferred to our intensive care unit in septic shock and multi-organ failure with bloody diarrhea and a megacolon on computed tomography (CT) scan. Emergency sigmoid colectomy was performed, however, the patient continued to have bloody diarrhea; subsequently, completion sub-total colectomy with ileost-omy was performed. On immunohistochemistry a diagnosis of CMV colitis was made; blood CMV poly-merase chain reaction (PCR) was positive, the patient tested positive for anti-CMV immunoglobulin (Ig) G but non-IgM antibodies. Ganciclovir was started and the patient's CMV PCR became negative within one week. The patient developed multiple other complications including Aspergillus tracheobronchitis, Pseu-domonas aeruginosa sepsis, and Candida krusei pneumonia, but ultimately recovered from the multiple infections. A low natural killer (NK) cell count (<1%) was found on immunologic workup; the patient tested negative for HIV. Conclusion: Cytomegalovirus colitis is a rare disease in the non-immunocompromised host but should be considered in patients with pseudomembranous colitis testing negative for clostridial toxin.