Cytomegalovirus colitis presenting as hematochezia and requiring resection
A. Escudero-Fabre, O. Cummings, J. K. Kirklin, R. C. Bourge and J. S. Aldrete
Department of Surgery, School of Medicine, University of Alabama, Birmingham 35294.
Cytomegalovirus infection is one of the most prevalent viral infections
affecting recipients of cardiac allografts. Of the various severe systemic
manifestations, those in the gastrointestinal tract have a unique way of
presenting, specifically in the colon where a process related to
cytomegalovirus infection that involves all layers, with dilatation as a
prominent clinical feature, has been suggested. We report herein a case of
patient with a heart allograft who had severe episodes of rejection that
responded to boosting doses of steroids. Because of persistent fever,
diarrhea, hematochezia, and computed tomographic findings of the abdomen
that showed a highly abnormal appearance of the ascending and transverse
segments of the colon, this patient subsequently underwent celiotomy. The
involved segment of the colon was found to have severe inflammation with
mucosal necrosis; a subtotal colectomy was done. The abundant
cytomegalovirus inclusions found in the vascular endothelium of the removed
damaged segment of the colon suggest that cytomegalovirus may have been a
causal factor in this form of colitis. The patient recovered uneventfully.
