Cytomegalovirus colitis presenting as massive lower gastrointestinal bleeding in an immunocompetent patient

Abstract

Cytomegalovirus infection is ubiquitous but often remains asymptomatic in affected patients. Symptomatic cytomegalovirus infection usually occurs in immunocompromised patients— patients who are infected with the Human Immunodeficiency Virus, have received organ transplantations, or are on immunosuppressive therapies. Cytomegalovirus colitis can present with abdominal pain, diarrhea and significant per rectal blood loss. It is a rare entity in immunocompetent patients and can often be missed unless one has a high index of suspicion. We describe a case of CMV colitis in a 78-year-old patient with no known risk factors for immunosuppression who was admitted for respiratory diseases and then subsequently developed transfusion dependent lower gastrointestinal bleeding. She ultimately required surgical resection of her colon. A literature review on CMV colitis, its myriad manifestations and therapeutic outcomes was conducted, with particular emphasis on its occurrence in immunocompetent patients.