We present a case of an 82-year-old immunocompetent man who presented with community-acquired bloody diarrhea. A computed tomography scan of the abdomen revealed pan-colitis. [ncbi.nlm.nih.gov]

• Weakness

  A 37-year-old woman developed acute onset of progressive dysarthria, dysphagia, and distal weakness of bilateral upper extremities. She had chronic myeloid leukemia and received bone marrow transplantation. [neurology.org]

  CMV can be transmitted sexually, through transplanted organs and blood transfusions. [2] CMV infection is usually seen in patients with weak immune system due to either chronic immunosuppressive diseases (human immunodeficiency virus [HIV], leukemia) [mjdrdypu.org]

  Giving antiviral medication in people who have a very weak immune system, such as bone marrow transplant recipients, improves prognosis. [medicinenet.com]

• Infectious Mononucleosis

  mononucleosis caused by EBV Unlike in infectious mononucleosis caused by EBV, a heterophile antibody test ( monospot test) is negative in cases of CMV. [amboss.com]

  Cytomegalovirus as a possible cause of a disease resembling infectious mononucleosis. Br Med J. 1965;2:1099-1102. Crossref 3. Jordan MC, Rousseau WE, Stewart JA, Molle GR, Chin TD. [jamanetwork.com]

  Acute CMV infection may mimic infectious mononucleosis caused by Epstein-Barr virus or liver infection by hepatitis A, B, or C. [medicinenet.com]

  Primary infection is often asymptomatic in the immunocompetent host but can cause a mild febrile illness and an infectious mononucleosis syndrome. [ncbi.nlm.nih.gov]

  Evans AS: Infectious mononucleosis and related syndromes. Am J Med Sci 1978;276:325-339. Handsfield HH, Chandler SH, Caine VA, et al: Cytomegalovirus infection in sex partners: evidence for sexual transmission. J Infect Dis 1985;151:344-348. [karger.com]

• Malnutrition

  The immunosenescence and protein-energy malnutrition increase incidence and severity of infectious diseases in elderly individuals. [ncbi.nlm.nih.gov]

  […] reactivation. [1], [6] The frequency of CMV reactivation increases linearly with age because of the decline in immunity. [1], [9] The other risk factors for CMV disease include co-morbidities such as diabetes mellitus, renal failure, severe sepsis, malnutrition [ijpmonline.org]

  […] immunosuppressive medications Transplantation patients (especially patients receiving CMV-positive organs) Hemodialysis Neoplasia Inflammatory bowel disease Alcoholism Collagen-vascular disease (seems to be related to immunosuppressive therapy) Blood transfusions Malnutrition [emedicine.medscape.com]

• Lymphadenopathy

  […] an increase in viral infections, due especially to CMV, but also to human parvovirus b 19, simplex herpes, varicella zoster and hepatitis A. 1 Viral infections may have symptoms identical to those of SLE, such as malaise, fever, arthralgia, a rash, lymphadenopathy [revistanefrologia.com]

  In immunocompetent patients > 90%: asymptomatic course < 10% : CMV mononucleosis Fever, malaise, myalgia / arthralgia, fatigue, headache Less common: sore throat, cervical lymphadenopathy, hepatomegaly, splenomegaly Differential diagnosis: infectious [amboss.com]

  CMV infection should be considered in IBD patients that present with fever, leukopenia, lymphadenopathy and splenomegaly [ 7 ]. However, CMV colitis need not have these features. [bmcgastroenterol.biomedcentral.com]

  In normal hosts, primary infection is usually asymptomatic, but sometimes can result in mononucleosis-like syndrome, accompanied by symptoms such as fever, myalgia, cervical lymphadenopathy and elevated liver enzymes [2]. [cureus.com]

  Primary CMV infection in immunocompetent individuals is usually asymptomatic, and rarely manifests itself as a mononucleosis-type disease similar to that caused by Epstein-Barr virus, consisting of fever, fatigue and cervical lymphadenopathy. [wjgnet.com]

• Sputum

  Nocardia spp were isolated from the sputum culture, antibiotic treatment begun and immunosuppressive medication was reduced. During hospitalisation, the patient developed fever, abdominal pain, vomiting and diarrhoea. [revistanefrologia.com]

• Diarrhea

  An 84-year-old male presented with chronic diarrhea and CMV colitis; he had been experiencing protracted diarrhea since 2006. In October 2009 he failed a 21-day course of valgancyclovir 900 mg orally twice daily. [ncbi.nlm.nih.gov]

• Abdominal Pain

  His age and abdominal pains suggested ischemic colitis as the cause of his bloody diarrhea. Workup for Clostridium difficile and all enteric pathogens were negative. The patient remained febrile with abdominal pain. [ncbi.nlm.nih.gov]

• Nausea

  A 21-year-old woman with Crohn disease presented to the hospital after 5 days of diffuse abdominal pain, nausea, vomiting, and watery diarrhea despite taking azathioprine (Imuran) 100 mg daily as maintenance therapy. [mdedge.com]

  These ulcers are associated with symptoms such as: Abdominal pain Difficulty swallowing or pain with swallowing Nausea Vomiting When the intestines are involved, the ulcers may cause: Abdominal pain Bloody stools Diarrhea Fever Weight loss More severe [medlineplus.gov]

  The most frequently reported secondary effect is taste disturbance (bitterness), and less common effects are gastrointestinal (diarrhea, nausea and vomiting) and rash, which has resulted in discontinuation of treatment in some cases. [revespcardiol.org]

  The signs and symptoms include: Ulcerous sores on the surface of the stomach and other gastrointestinal regions, making it painful and difficult to swallow Nausea, vomiting Loss of appetite, weight loss, general malaise Constipation, or watery/bloody [dovemed.com]

• Rectal Bleeding

  A 5-week-old, severely ill, infant is described with diarrhoea and rectal bleeding, followed by vomiting and dehydration after introduction of a cow's milk formula. [ncbi.nlm.nih.gov]

  Life-threatening rectal bleeding due to cytomegalovirus colitis in a haemodialysis patient. Clin Kidney J 2009;2:239-41. 2. Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. [ijpmonline.org]

• Chronic Diarrhea

  Other pathogens should be considered in patients with chronic diarrhea who are refractory to initial treatments. [ncbi.nlm.nih.gov]

  The infectious disease team was consulted and it was determined that in the context of the patient's HIV infection, AIDS and resultant immunosuppression, CMV infection was contributing to chronic diarrhea, abdominal pain, and formation of a colovesical [cureus.com]

  Diagnostic Accuracy of Fecal Calprotectin Assay in Distinguishing Organic Causes of Chronic Diarrhea from Irritable Bowel Syndrome: A Prospective Study in Adults and Children. Clinical Chemistry 49:6 861–867. [labtestsonline.it]

  It supports our policy of performing colonoscopy instead of flexible sigmoidoscopy in evaluation of HIV + patients with chronic unexplained diarrhea or gastrointestinal bleeding. [scielo.br]

• Tachycardia

  Clinical examination revealed tachycardia, tachypnea, a temperature of 38.3° C, and diffuse abdominal pain, combined with massive pain on rectal examination. [academic.oup.com]

  On examination, salient clinical findings were tachycardia, pallor, and pedal edema. [jdeonline.in]

• Skin Rash

  In the physical examination we did not find any significant clue such as fever, organomegaly, skin rash, trush and the anus was normal with no fissure or ulcer. [ijp.mums.ac.ir]

• Arthralgia

  […] infections, however, there is an increase in viral infections, due especially to CMV, but also to human parvovirus b 19, simplex herpes, varicella zoster and hepatitis A. 1 Viral infections may have symptoms identical to those of SLE, such as malaise, fever, arthralgia [revistanefrologia.com]

  In immunocompetent patients > 90%: asymptomatic course < 10% : CMV mononucleosis Fever, malaise, myalgia / arthralgia, fatigue, headache Less common: sore throat, cervical lymphadenopathy, hepatomegaly, splenomegaly Differential diagnosis: infectious [amboss.com]

  He denied fever, recent antibiotic usage, arthralgias, rash, and use of nicotine, alcohol, or any illicit drugs. He denied use of steroids, immune-suppressive medication, or herbal medications. [acgcasereports.gi.org]

• Muscle Cramp

  Again, muscle cramps and hypocalcemia developed, with worsening renal function (Creatinine: 3 mg/dL) and neutropenia (2.200 leukocytes/mm 3 ) associated with foscarnet and valganciclovir. [revespcardiol.org]

• Withdrawn

  Treatment with i.v. ganciclovir was begun and the MMF treatment withdrawn, with clinical improvement and a negative antigenaemia for CMV. [revistanefrologia.com]

  The most common side effect of GCV is neutropenia, which arises in 20% to 40% of patients and is reversible after drug withdrawn. [omicsonline.org]

• Confusion

  […] especially to CMV, but also to human parvovirus b 19, simplex herpes, varicella zoster and hepatitis A. 1 Viral infections may have symptoms identical to those of SLE, such as malaise, fever, arthralgia, a rash, lymphadenopathy and cytopaenias, so it may be confused [revistanefrologia.com]

  Furthermore, the diagnositic confusion may also result in implementation of multiple unsuccessful treatment strategies, especially in immunocompetent individuals. [cureus.com]

  Third, certain presentations of CMV disease strongly mimic other diseases, potentially causing diagnostic confusion and delay in diagnosis. [mja.com.au]

  Treatment with ganciclovir for 2-3 weeks should be sufficient for resolution of colitis. 18, 19, 20 Ganciclovir treatment may also result in dose-related granulocytopenia and mental confusion which may affect treatment. [ispub.com]

  It has been described in the literature in patients immunocompromised by HIV; however, the absence of risk factors means that it can be confused with a primary neoformative process. New comment Comments No comments for this article References 1. [reed.es]

Workup for Clostridium difficile and all enteric pathogens were negative. The patient remained febrile with abdominal pain. [ncbi.nlm.nih.gov]

Coverage begins with the patient's first visit and proceeds through the diagnostic workup: endoscopy, radiologic testing, and instruments for rating and classifying inflammatory bowel disease. [books.google.de]

Workup revealed intussusception with associated pneumatosis. A right hemicolectomy was performed. Pathologic examination revealed cytomegalovirus (CMV) colitis. [austinpublishinggroup.com]

"Cytomegalovirus (CMV) Workup." Medscape.com. Dec. 1, 2017.. Azevedo, L.S., et al. "Cytomegalovirus infection in transplant recipients." Clinics (Sao Paulo) 70.7 July 2015: 515-23. doi: 10.6061/clinics/2015(07)09. Epub 2015 Jul 1. Review. [medicinenet.com]

• Rectal Ulcer

  Colonoscopy revealed multiple clean base ulcers at rectum and sigmoid colon. An active bleeding lesion was rectal ulcer with non bleeding visible vessel which was successfully treated with hemoclipping. [ncbi.nlm.nih.gov]

  We reported a case of CMV gastroenterocolitis with a gastric and a rectal ulcer in a non-immunodeficiency late elderly woman. Copyright © 2012, Igaku-Shoin Ltd. All rights reserved. 基本情報 胃と腸 47巻12号 （2012年11月） 電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院 [webview.isho.jp]

  Cytomegalovirus associated rectal ulcer as manifestation of primary HIV infection. Rev Esp Enferm Dig. 2022 Jan 24. 4. Mourad FH, Hashash JG, Kariyawasam VC, et al. Ulcerative Colitis and Cytomegalovirus Infection: From A to Z. [reed.es]

• Colitis

  CMV colitis (flickr.com/lunar caustic) CMV colitis (unibas.ch). IHC CMV +ve. Increases the sensitivity (compared to H&E alone). [3] Others: HSV-1. HSV-2. VZV. EBV. Images CMV colitis - IHC (nih.gov). [4] See also Colitis. Colon. [librepathology.org]

  Our experience suggests that biopsies may be necessary to detect CMV and the prompt management of CMV colitis should be instituted when intractable ischemic colitis is observed. [ncbi.nlm.nih.gov]

• Intranuclear Inclusion Bodies

  Colonic mucosal intranuclear inclusion bodies were found in 12 patients. Thirteen patients had cytomegalovirus viraemia (either by polymerase chain reaction and/or by white blood cell-cytomegalovirus antigenaemia test). [ncbi.nlm.nih.gov]

  Repeated sigmoidoscopic examination with re-biopsy showed intranuclear inclusion bodies suggestive of CMV infection. After administration of Ganciclovir, abdominal pain and bloody diarrhea improved. [ekjm.org]

  A biopsy specimen revealed intranuclear inclusion bodies, so we diagnosed that this case was UC associated with CMV infection. CMV infection often occurs in im-munocompromised hosts. [ci.nii.ac.jp]

  inclusion bodies that have an owl-eye appearance Monospot (heterophile antibody ) test : negative Serological tests Direct evidence of viremia : especially useful in immunosuppressed patients PCR to detect CMV DNA in bodily fluids Indirect immunofluorescence [amboss.com]

  inclusion bodies (Cowdry bodies) surrounded by a clear halo, giving the appearance of an owl's eye Cells show a thickened nuclear membrane and smaller granular intracytoplasmic inclusions Many of these infected cells can be seen surrounding blood vessels [pathologyoutlines.com]

• Viral Inclusion Body

  Light microscopy of selected viral diseases (morphology of viral inclusion bodies). Pathol Annu 1976;11:53-75. [ PUBMED ] 34. Schwartz DA, Wilcox CM. [jdeonline.in]

CONCLUSION: In IBD patients with active CMV colitis, antiviral treatment seems to have a marginal impact in the short term, during the treatment of the acute phase, but it may have some beneficial effect in maintaining remission up to 1 year of follow-up [ncbi.nlm.nih.gov]

Despite aggressive clinical manifestations, the prognosis of CMV colitis is good if diagnosed and treated early. [ncbi.nlm.nih.gov]

In patients without immunocompromised status, the prognosis appears to be age dependent, with patients older than 55 years having a higher mortality. Males and patients who need surgery also have a poorer prognosis. [emedicine.medscape.com]

[…] the case of a patient who presented with abdominal pain 4 years after heart transplantation; clinical and x-ray findings were suggestive of a neoplastic or ischemic stenosis, and histopathological examination likewise initially suggested an ischemic etiology [ncbi.nlm.nih.gov]

Etiology Pathogen : cytomegalovirus ( CMV, human herpes virus 5, HHV-5 ) Transmission Blood transfusions Sexual transmission Droplet transmission Transplant-transmitted infection (e.g., bone marrow, lungs, kidneys) References: [1] [2] [3] Pathophysiology [amboss.com]

Physical exam is often not specific to the diagnosis of CMV colitis; fever in these patients can be indicative of an infectious etiology. [clinicaladvisor.com]

Etiology and management of toxic megacolon in patients with human immunodeficiency virus infection. Gastroenterology. 1994;107:858-63. [ Links ] 2. Bini EJ, Cohen J. [scielo.br]

Search for other works by this author on: Ulrich von Both 1Division of Infectious Diseases and Hospital Epidemiology, Zurich, Switzerland Search for other works by this author on: Reto Laffer 1Division of Infectious Diseases and Hospital Epidemiology, [academic.oup.com]

Epidemiology Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Jeffrey D Band, MD, FACP, FIDSA Professor of Medicine, Oakland University William Beaumont School of Medicine; Health System Chair, Healthcare Epidemiology and International Medicine, Beaumont Health System; Former Chief of Infectious Diseases, Beaumont [emedicine.medscape.com]

[…] antiviral drugs, such as ganciclovir or valganciclovir Terminology CMV infection: refers to presence of detectable CMV levels in the human body CMV disease: CMV disease relates to symptoms due to CMV ICD coding B25.8: other cytomegaloviral diseases Epidemiology [pathologyoutlines.com]

Etiology Pathogen : cytomegalovirus ( CMV, human herpes virus 5, HHV-5 ) Transmission Blood transfusions Sexual transmission Droplet transmission Transplant-transmitted infection (e.g., bone marrow, lungs, kidneys) References: [1] [2] [3] Pathophysiology [amboss.com]

Infection can be acquired during birth, breast feeding, close contact, sexual contact, transfusion or with organ transplant (Scand J Gastroenterol 2010;45:1295) Sites Most common sites of CMV related gastrointestinal involvement are the esophagus and colon Pathophysiology [pathologyoutlines.com]

This activity reviews cytomegalovirus colitis and focuses on the etiology, epidemiology, pathophysiology, evaluation, management, and complications of cytomegalovirus colitis and highlights the role of an interprofessional team in improving healthcare [ncbi.nlm.nih.gov]

The pathophysiology of a disease may compromise the immune system. [journals.plos.org]

Pathophysiology Cytomegalovirus (CMV) has 3 major patterns of infection. [emedicine.medscape.com]

Is it possible to prevent cytomegalovirus infection? Is there a CMV vaccine? Because CMV is a common virus, it is not always possible to prevent infection. Pregnant women should take precautions to prevent congenital CMV infection. [medicinenet.com]

Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the [karger.com]

CMV: Prevention, Diagnosis and Therapy. Am J Transplant. 2013 Feb;13 Suppl 3:24-40; quiz 40. [PubMed: 23347212] 27. [ncbi.nlm.nih.gov]