Cytomegalovirus associated toxic megacolon in an immunocompetent host. A case report

BACKGROUND: Cytomegalovirus (CMV) has been proven to cause lethal infections in patients with immune dysfunction, whereas in normal individuals it is mostly asymptomatic or leads to mild self-limiting infections. METHODS (CASE REPORT): We describe a case of fulminant toxic megacolon caused by CMV in an immunocompetent patient. Etiologic diagnosis remained elusive despite comprehensive workup. As the patient presented with severe sepsis, he underwent emergency subtotal colectomy and splenectomy due to splenic inflammation and adhesion to the colon. Histopathology showed CMV colitis with acute septic splenitis. Postoperatively patient recuperated well after a prolonged hospital course and was discharged. RESULTS AND CONCLUSIONS: CMV colitis in immunocompetent hosts is a rare entity. It should be suspected when a patient has typical manifestations of colitis and the diagnosis remains uncertain after the usual workup. Diagnosis may remain elusive even after endoscopic biopsy, which is considered to be the gold standard, as the biopsy may not be from a representative area, as happened in our case. In such a situation, consideration should be given to plasma or tissue PCR testing for CMV in order to establish the diagnosis, so that the antiviral therapy can be started at the earliest opportunity, as the mortality of delayed diagnosis is unacceptable.