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]

• 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]

• Hematochezia

  This is the first reported case of the use of octreotide in the treatment of massive hematochezia from CMV colitis. [ncbi.nlm.nih.gov]

• 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]

• Blood in Stool

  Diagnostic tests that are performed include: Physical exam and medical history evaluation Colonoscopy or sigmoidoscopy; to visualize the region and obtain specimens for biopsy CMV antigenemia test; to diagnose any CMV infection Culture of blood, stool [dovemed.com]

  The laboratory evaluation was significant for C-reactive protein 18.3 mg/dL (normal During the initial days of his hospitalization, the diarrhea worsened and was accompanied by blood in stools. The patient developed a mild fever of 38℃. [cureus.com]

  We found that, in patients with mild and moderate forms of CD and UC, there was no association between the severity of IBD and CMV viral replication in the blood or stool specimens. [journals.plos.org]

• Difficulty Concentrating

  Personality changes, difficulty concentrating, headaches, and somnolence are frequently present. [hivinsite.ucsf.edu]

• Asthenia

  We report the case of a 42-year-old male admitted for diarrhoea, asthenia and generalized oedema. He was an alcoholic, with no other known disease and no laboratorial evidence of immunosuppression. [scielo.mec.pt]

• Urinary Retention

  It can induce Guillain-Barre syndrome with urinary retention and ascending motor weakness of both lower limbs [ 30 ]. [omicsonline.org]

  Central Nervous System Disease A distinct neurologic syndrome caused by CMV in patients with AIDS is radiculopathy, a spinal cord syndrome characterized by lower extremity pain and weakness, spasticity, areflexia, urinary retention, and hypoesthesia. [hivinsite.ucsf.edu]

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]

• Lymphocytosis

  Adrenal insufficiency CMV encephalitis : impaired cognitive function, neurological deficits References: [2] [4] [1] [5] [6] [7] [8] [9] Diagnostics CBC : relative lymphocytosis with > 10% atypical lymphocytes and sometimes pancytopenia Blood smear : : [amboss.com]

  […] any patient diagnosed with CMV gastrointestinal disease should have a formal ophthalmologic examination Classic mononucleosis can occur due to CMV in immunocompetent patients, and presents as protracted fevers and lassitude in the setting of absolute lymphocytosis [pathologyoutlines.com]

  CMV Disease is the presence of CMV infection, evident as: CMV Syndrome, a clinical condition characterized by fever ≥ 101 ºF (≥ 38.3ºC) at least twice within 7 days, muscle pain, leukopenia ≤ 3500/μl, neutropenia ≤ 1,500/μl, atypical lymphocytosis ≥ 5% [intechopen.com]

• 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]

• 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]