Acute appendicitis due to Cytomegalovirus in an apparently immunocompetent patient: a case report

Abstract

Introduction: In healthy subjects, Cytomegalovirus infection can be asymptomatic or manifest as mononucleosis syndrome, but organ disease has also been reported. However, in immunocompromised patients this infection can lead to its most significant and severe disease and even mortality. When Cytomegalovirus causes a gastrointestinal tract infection, it more commonly manifests with luminal tract disease and is usually characterized by ulcerative lesions. Appendicitis is a rare manifestation, and has been reported mainly in human immunodeficiency virus-infected patients or patients with other causes of immunocompromise.

Case presentation: The authors report on a case of acute primary Cytomegalovirus infection complicated with acute appendicitis due to Cytomegalovirus in an apparently immunocompetent 24-year-old Caucasian man also suffering from primary sclerosing cholangitis and ulcerative colitis. Diagnosis was based on clinical manifestations, serology results, as well as microbiological and histological findings. Treatment consisted of surgery and anti-Cytomegalovirus therapy.

Conclusions: Cytomegalovirus should be included among the etiologic agents of acute appendicitis in patients with primary sclerosing cholangitis and ulcerative colitis. Currently, there are no definitive data regarding the frequency of Cytomegalovirus appendicitis and the role of anti-Cytomegalovirus treatment in human immunodeficiency virus-negative and apparently immunocompetent subjects.

Figure 1

Magnetic resonance showing bile duct irregularities (a); T2-weighted image, depicting hepatic hilum tissue with contrast enhancement (b).

Figure 2

Acute catarrhal appendicitis (a); abdominal ultrasound showing “finger in glove” anechoic image with incompressible lumen (b).

Figure 3

Appendix section: early Cytomegalovirus antigens (Monoclonal Mouse Anti-Cytomegalovirus Clone CCH2?+?DDG9, Ventana Medical System, Roche, USA).