Cytomegalovirus-induced colonic stricture presenting as acute intestinal obstruction in an immunocompetent adult

Abstract

Cytomegalovirus (CMV) infection causes significant morbidty and mortality in immunopromised patients. Though it is usually silent in immunocompetent adults, rarely it can cause serious life-threatening complications. Gastrointestinal tract is one of the commonly involved organs, where it produces a spectrum of clinical manifestation ranging from mild non-specific abdominal pain and diarrhoea to severe infection with toxic megacolon and death. We present a 65-year-old immunocompetent male patient admitted with acute colonic obstruction secondary to CMV-induced colonic stricture, highlighting the importance of considering it as a differential diagnosis for colonic obstruction and reviewing its management.

Figure 1

Plain abdominal radiography showing dilated small and large bowel with multiple air fluid level.

Figure 2 Contrast-enhanced CT

abdomen and pelvis showing circumferentially enhancing short-segment stricture at the descending colon—sigmoid colon junction (arrow).

Figure 3

Sigmoidoscopy showing the stricturous lesion in the sigmoid colon.

Figure 4

Intranuclear eosinophilic inclusion (arrow) suggestive of cytomegalovirus (H&E, ×200).