Cytomegalovirus colitis: an unusual cause for diarrhoea in the immunocompetent
The Journal of the Royal College of Physicians of Edinburgh
A 72-year-old woman was admitted to hospital with lower abdominal pain and diarrhoea. She had woken up suddenly in the middle of the night with abdominal pain and an episode of loose stool associated with fresh rectal bleeding and two bouts of vomiting. Her medical history consisted of late-onset asthma diagnosed five years previously, for which she was prescribed inhalers (tiotropium, fluticasone/salmeterol and salbutamol). However, she had not been using any of these inhalers for at least a
... rs for at least a year prior to admission. The patient had never taken oral steroids for her asthma. She consumed 20 units of alcohol a week and had stopped smoking 20 years previously. There was no history of recent travel or intake of antibiotics in the last few months. Examination revealed severe tenderness in the left flank, with localised guarding and exaggerated bowel sounds. An initial impression was made of sigmoid diverticulitis, and the patient was admitted under the surgeons. ABSTRACT Cytomegalovirus (CMV) colitis is rarely reported in the immunocompetent adult and is often associated with inflammatory bowel disease (IBD), particularly ulcerative colitis (UC). An index of suspicion in the appropriate setting is vital to diagnosing the condition. Undiagnosed CMV colitis has a significant morbidity. A review of the natural history and diagnosis of CMV is followed by a discussion of the incidence, outcome and possible treatment of CMV in the immunocompetent patient. The possible association between CMV and IBD is also reviewed, and the question of whether this should have any bearing on treatment is discussed at some length.