SHM Converge Scientific Abstract ePoster Gallery-Persistent Fever and Thrombosis: A Vexing Presentation of CMV Colitis

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A 59-year-old man with a remote history of indeterminate ulcerative colitis, treated with azathioprine and mesalamine, was admitted with two weeks of fever, fatigue, and non-bloody diarrhea after recent Augmentin use. He had no abdominal pain or bleeding, and initial findings were nonspecific: normal white count, thrombocytopenia, electrolyte abnormalities, low albumin, and mild liver enzyme elevation. CT imaging showed transverse colitis and thrombosis involving the portal vein confluence and inferior mesenteric vein, prompting anticoagulation and empiric antibiotics. An extensive infectious workup was initially unrevealing, and a UC flare seemed less likely because of the lack of classic symptoms and exam findings.  <br /><br />Despite treatment, fevers persisted. Further evaluation ruled out lymphoma and murine typhus, but CMV PCR later returned strongly positive at 5 million copies/mL. Colon biopsy confirmed CMV colitis without active inflammatory bowel disease. IV antiviral therapy was started, leading to improvement in fever and reduction in viral burden, followed by transition to oral therapy and eventual symptom resolution.  <br /><br />This case highlights that CMV colitis can present atypically in patients with IBD, even without hematochezia, abdominal pain, or known prior CMV infection. Venous thromboembolism may also accompany CMV colitis and can be mistaken for an IBD-related prothrombotic complication. In stable IBD patients who develop persistent fever, nonspecific systemic illness, diarrhea, and thrombosis, CMV colitis should be considered early to avoid delayed diagnosis and treatment.

Asset Subtitle

Haseeb Ikram

Meta Tag

Author List Hansen Nguyen, Haseeb Ikram, Quratulanne Jan

Category Clinical Vignettes

Concept CMV Colitis

Concept Inflammatory Bowel Disease

Concept Fever

Concept Venous Thromboembolism

Concept Diagnosis

Distinguished Non-Finalist

Presenter Organization Utmb

Presenting Author Haseeb Ikram

Track Adult

Keywords

CMV colitis

ulcerative colitis

fever

diarrhea

portal vein thrombosis

inferior mesenteric vein thrombosis

immunosuppression

azathioprine

antiviral therapy

inflammatory bowel disease

CMV Colitis

Inflammatory Bowel Disease

Fever

Venous Thromboembolism

Diagnosis