Published online Aug 21, 2016. doi: 10.3748/wjg.v22.i31.7166
Peer-review started: April 8, 2016
First decision: May 27, 2016
Revised: June 14, 2016
Accepted: June 28, 2016
Article in press: June 28, 2016
Published online: August 21, 2016
Involvement of gastrointestinal tract by cytomegalovirus (CMV) is common. CMV infections mainly run their course without any clinical signs in immunocompetent hosts. In contrast, CMV can cause severe infections with serious consequences in a immunocompromised state typically associated with organ transplants, highly immunosuppressive cancer chemotherapy, advanced HIV infection or treatment with corticosteroids. The incidence and severity of these manifestations of CMV is directly proportional with the degree of cellular immune dysfunction, i.e., CD8+ Cytotoxic T-cell response. Clinical manifestations of CMV can become apparent in different situations including reactivation of CMV from latency, primary infection in a seronegative host, or exposure of a seropositive host to a new strain of CMV. As the clinical signs of CMV in immunodeficient patients are usually sparse, physicians should be highly vigilant about CMV infection, a treatable condition that otherwise is associated with significant mortality. Here we report a rare case of severe gastrointestinal CMV infection with sustained immunodeficiency secondary to treatment with steroids manifesting as fatal duodenal diverticular bleeding.
Core tip: Cytomegalovirus (CMV) can establish as latent infection that can lead to reactivation with immunosuppression. It can affect almost any organ system with gastrointestinal tract involvement being most common. In gastrointestinal tract, besides causing mucosal inflammation, rarely gastrointestinal perforation or hemorrhage may occur. High clinical suspicion is needed for timely diagnosis, as clinical signs are usually sparse for this fatal yet treatable CMV infection.