SHM Converge Scientific Abstract ePoster Gallery-Rare Case of Cytomegalovirus Infection in an Ulcerative Colitis Patient

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A 56-year-old man with ulcerative colitis on adalimumab developed 5 days of high fever, chills, fatigue, poor intake, and worsening diarrhea after returning from a cruise to Puerto Rico. He was initially admitted with presumed acute colitis and treated with broad-spectrum antibiotics, but infectious workup was negative and he remained persistently febrile and clinically worse. Labs showed bandemia, thrombocytopenia, and elevated liver enzymes, and CT demonstrated colitis consistent with UC. Over the hospital course, he developed bloody stools, worsening transaminitis, hepatosplenomegaly, and progressive pancolitis/proctitis.<br /><br />Extensive testing for travel-related and systemic infections was negative, including malaria, EBV, HIV, dengue, Q fever, Bartonella, Ehrlichia, chikungunya, syphilis, RMSF, and Lyme disease. Flexible sigmoidoscopy on day 6 showed severe rectal inflammation with ulcers and edema; biopsies revealed active colitis, and CMV immunohistochemistry was positive. CMV IgM and plasma CMV DNA were also elevated, confirming CMV colitis superimposed on UC. Budesonide was stopped, and valganciclovir was started on day 9, but his symptoms continued to worsen, with significant weight loss and poor oral absorption suspected. Repeat imaging and sigmoidoscopy showed worsening severe colitis, and treatment was escalated to intravenous ganciclovir.<br /><br />This case highlights that CMV colitis can mimic or exacerbate ulcerative colitis and may be difficult to diagnose without biopsy and immunohistochemical staining. It emphasizes maintaining a high index of suspicion in immunosuppressed UC patients with severe, steroid- or antibiotic-refractory illness, since prompt recognition and treatment with ganciclovir are critical.

Asset Subtitle

Sanil S. Modi

Meta Tag

Author List George W. Garriss III, Rabia Khan, Sanil S. Modi, Usha Anand

Category Clinical Vignettes

Concept CMV Colitis

Concept Ulcerative Colitis

Concept Biopsy

Concept Tissue Diagnosis

Concept Immunosuppression

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Hospital

Presenting Author Sanil S. Modi

Track Adult

Keywords

ulcerative colitis

CMV colitis

adalimumab

immunosuppressed

fever

bloody diarrhea

transaminitis

hepatosplenomegaly

ganciclovir

biopsy

CMV Colitis

Ulcerative Colitis

Biopsy

Tissue Diagnosis

Immunosuppression