Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 28, 2015; 21(12): 3750-3754
Published online Mar 28, 2015. doi: 10.3748/wjg.v21.i12.3750
Cytomegalovirus colitis followed by ischemic colitis in a non-immunocompromised adult: A case report
Tsuyoshi Hasegawa, Kazuki Aomatsu, Masanori Nakamura, Naoki Aomatsu, Keiho Aomatsu
Tsuyoshi Hasegawa, Kazuki Aomatsu, Masanori Nakamura, Naoki Aomatsu, Keiho Aomatsu, Department of Surgery, Aomatsu Memorial Hospital, Izumisano, Osaka 598-0001, Japan
Kazuki Aomatsu, Department of Gastroenterology, Izumiohtsu City Hospital, Izumiohtsu, Osaka 595-0027, Japan
Naoki Aomatsu, Department of Surgery, Fuchu Hospital, Izumi, Osaka 594-0076, Japan
Author contributions: Hasegawa T, Aomatsu K and Aomatsu K designed the report; Hasegawa T and Aomatsu K diagnosed the case; Hasegawa T, Aomatsu K and Nakamura M treated the patient; Hasegawa T and Aomatsu N collected the patient’s clinical data; Hasegawa T and Aomatsu K analyzed the data and wrote the manuscript.
Ethics approval: This case was reviewed and approved by the Aomatsu Memorial Hospital Institutional Review Board.
Informed consent: In this case, the patient agreed with the treatment and gave informed consent prior to treatment.
Conflict-of-interest: The authors declare no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Tsuyoshi Hasegawa, MD, Department of Surgery, Aomatsu Memorial Hospital, 876-1 Kamikawaraya, Izumisano, Osaka 598-0001, Japan.
Telephone: +81-7-24633121 Fax: +81-7-24636616
Received: October 8, 2014
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

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.

Keywords: Cytomegalovirus infection, Colitis, Ischemic colitis, Non-immunosuppression, Infectious disease

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.