SHM Converge Scientific Abstract ePoster Gallery-CMV Colitis in an Immunocompetent Host

Pdf Summary

This case report describes a rare instance of severe cytomegalovirus (CMV) colitis in an immunocompetent 76-year-old woman. CMV is a common DNA virus that is usually asymptomatic in healthy individuals, but it can cause serious disease, especially in immunocompromised patients. Colitis in an immunocompetent host is uncommon and poorly understood.

The patient presented with bloody diarrhea, weakness, abdominal pain, and lower extremity edema. Her history included incarcerated hernia, prior <em>Clostridium difficile</em> colitis, hypertension, and dyslipidemia. Initial evaluation showed neutropenia with lymphocytosis, mild hyponatremia, and positive CMV IgG, while HIV testing and immunoglobulin levels were normal, supporting an apparently immunocompetent status. Colonoscopy and rectal biopsy confirmed severe active CMV colitis with crypt architectural distortion.

She was treated with a six-week course of valganciclovir and discharged after improvement. However, she continued to have diarrhea and fecal urgency at follow-up. Two weeks later, she returned with abdominal pain and shortness of breath and rapidly deteriorated. Imaging showed pancolitis, and cardiopulmonary findings suggested stress cardiomyopathy with reduced ejection fraction. Her condition worsened despite intensive care, and the family chose hospice. She died a few days later.

The discussion emphasizes that CMV colitis can occur even in immunocompetent patients, though it is rare. Reported risk factors for worse outcomes include older age, male sex, and comorbidities. The literature suggests that CMV reactivation may contribute to severe colitis in a subset of cases, but the true prevalence in immunocompetent hosts is unknown. Evidence for antiviral treatment outcomes is limited, though ganciclovir remains the standard therapy. The case highlights the importance of considering CMV in older patients with severe or unexplained colitis, even without classic immunosuppression.

Asset Subtitle

Devesh Kumar

Meta Tag

Author List Devesh Kumar, Divya Divya, Evanka Annyapu, Nisar Asmi

Category Clinical Vignettes

Concept Cytomegalovirus Infection

Concept CMV Colitis

Concept Immunocompromised State

Concept Bloody Diarrhea

Concept Colonoscopy

Distinguished Non-Finalist

Presenter Organization Medical College of Wisconsin

Presenting Author Devesh Kumar

Track Adult

Keywords

cytomegalovirus

CMV colitis

immunocompetent

bloody diarrhea

valganciclovir

colonoscopy

rectal biopsy

pancolitis

stress cardiomyopathy

older adult

Cytomegalovirus Infection

CMV Colitis

Immunocompromised State

Bloody Diarrhea

Colonoscopy