CYTOMEGALOVIRAL ENTERITIS: A RARE CAUSE OF SMALL GUT PERFORATION

Authors

  • Maqbool Ahmed
  • Sohail Saqib
  • Mannan Masud
  • Aurangzeb Aurangzeb
  • Abeerah Pervez
  • Zainab Kamal
  • Raheel Khan

Abstract

A 47-year-old man was admitted with four months history of pain upper central abdomen associated
with passage of 3-4 loose watery stools per day. Abdominal examination revealed soft abdomen with
mild tenderness in the para-umbilical region. There was associated hepatomegaly. His Hb% was low,
liver and renal functions were deranged. Upper GI endoscopy revealed antral ulcer, and colonoscopy
revealed a caecal ulcer, which were biopsied. Liver biopsy was also done. Histopathology report showed
evidence of inflammatory colitis and chronic hepatitis, so a diagnosis of inflammatory bowel disease
with autoimmune hepatitis was made. He was negative for HIV and hepatitis serology. He was given
long list of medicine including steroids but the symptoms did not improve. Two months after admission
he developed severe abdominal pain associated with distension. The X-Ray chest revealed
pneumoperitoneum and laparotomy was carried out which revealed a small perforation in terminal ileum
associated with multiple circular indurated areas ranging from few mm to 1.5 Cm in size with central
thinning spread over distal half of small gut and enlarged mesenteric lymph nodes. The biopsy of
perforated area revealed cytomegaloviral enteritis. Postoperatively patient developed ARDS and died on
13th postoperative day.
Keywords: Cytomegalovirus, CMV, Perforation, ileal

References

Jacobson MA, Mills J. Serious cytomegalovirus disease in the

acquired immune deficiency syndrome. Ann Int med

;108:585-94.

Eyre-Brook IA, Dundas S. Incidence and clinical significance of

colonic cytomegalovirus infection in idiopathic inflammatory

bowel disease requiring colectomy. Gut 1986;27:1419-25.

Krech U. Complement-fixing antibodies against cytomegalovirus

in different parts of the world. Bull World Health Organ

;49:103-6.

Weber R, Ledergerber B, Zbinden R, Altwegg M, Pfyffer GE,

Spycher MA, et al. Enteric infections and diarrhea in human

immunodeficiency virus-infected persons: Prospective

community-based cohort study. Swiss HIV Cohort Study. Arch

Intern Med 1999;159:1473-80.

Dolgin SE, Larsen JG, Shah KD, David E. CMV enteritis

causing hemorrhage and obstruction in an infant with AIDS. J

Pediatr Surg 1990;25:696-8.

Lai IR, Chen KM, Shun CT, Chen MY. Cytomegalovirus

enteritis causing massive bleeding in a patient with AIDS.

Hepatogastroenterology 1996;43:987-91.

Chamberlain, RS, Atkins, S, Saini, N, White, JC. Ileal perforation

caused by cytomegalovirus infection in a critically ill adult. J Clin

Gastroenterol 2000;30:432.

Dieterich DT, Poles MA, Lew EA, Martin-Munley S, Johnson

J, Nix D, et al. Treatment of gastrointestinal cytomegalovirus

infection with twice-daily foscarnet: a pilot study of safety,

efficacy, and pharmacokinetics in patients with AIDS.

Antimicrob Agents Chemother 1997;41(6):1226-30.

Nelson, MR, Connolly, GM, Hawkins, DA, Gazzard, BG.

Foscarnet in the treatment of cytomegalovirus infection of the

esophagus and colon in patients with the acquired immune

deficiency syndrome. Am J Gastroenterol 1991;86:876.

Wani RA, Parray FQ, Bhat NA, Wani MA, Bhat TH, Farzana F.

Nontraumatic terminal ileal perforation. World J Emerg Surg

;1:7.

Stoner MC, Forsythe R, Mills AS, Ivatury RR, Broderick TJ.

Intestinal perforation secondary to Salmonella typhi: case report

and review of the literature. Am Surg 2000;66:219-22.

Published

2011-12-01

How to Cite

Ahmed, M., Saqib, S., Masud, M., Aurangzeb, A., Pervez, A., Kamal, Z., & Khan, R. (2011). CYTOMEGALOVIRAL ENTERITIS: A RARE CAUSE OF SMALL GUT PERFORATION. Journal of Ayub Medical College Abbottabad, 23(4), 133–134. Retrieved from https://demo.ayubmed.edu.pk/jamc/index.php/jamc/article/view/2409