Cytomegalovirus Colitis Followed by Colonic Pseudolipomatosis and Gastric Emphysema in a Post-resuscitation Patient

Abstract

A 64-year-old Japanese man suffered cardiopulmonary arrest, which may have resulted from sepsis and/or hyperosmolar hyperglycemic non-ketonic coma, and was admitted after successful resuscitation. He had watery diarrhea on day 18 and was diagnosed with cytomegalovirus enterocolitis. In addition, computed tomography performed on day 27 and colonoscopy revealed gastric emphysema and intestinal pseudolipomatosis, respectively. This report is the first to describe a patient with cytomegalovirus enterocolitis and subsequent gastric emphysema and pseudolipomatosis. Gastrointestinal cytomegalovirus infection may underlie gastric emphysema and intestinal pseudolipomatosis, particularly in patients with relative or obvious immune dysfunction.

Keywords: cytomegalovirus colitis; diabetes mellitus; gastric emphysema; post-resuscitation; pseudolipomatosis.

Figure 1.

Clinical course of the patient. CT: computed tomography, EGD: esophagogastroduodenoscopy, CTRX: ceftriaxone, TAZ/PIPC: tazobactam/piperacillin, ABPC/SBT: sulbactam/ampicillin, CMZ: cefmetazole

Figure 2.

Computed tomography images. Circumferential wall thickening of the rectum is observed on day 20 (A). Rectal wall thickening is also seen on day 26 (B). Gastric emphysema (C) and hepatic portal venous gas (D) are also seen.

Figure 3.

Esophagogastroduodenoscopy images of gastric emphysema. Diffuse edema and multiple longitudinal areas of redness and erosion are seen in the gastric fundus and gastric body (A, B). The gastric antrum is also involved (C).

Figure 4.

Colonoscopy images of the rectum. Large ulcers (A, B) and aphthous lesions (C) are found in the rectum. Infiltration of neutrophils and lymphocytes is seen in the biopsy specimen (D). Cytomegalovirus-positive cells are also seen (E).

Figure 5.

Colonoscopy images of the ileum. Reddish lesions with microbubbles are seen in the ileum (A, B). Narrow-band imaging shows the microbubbles as round, whitish deposits (C). Optically empty coalescent vacuoles are seen in the biopsy specimen (D). Cytomegalovirus-positive cells are also present (E).

Figure 6.

Colonoscopy images of the ascending colon. White lesions are seen (A), and the biopsy specimens show small vacuoles within the mucosa (B), indicating pseudolipomatosis.

Figure 7.

Images from esophagogastroduodenoscopy and colonoscopy repeated after two weeks. Improvements are noted in the gastric (A-C), rectal (D), and colonic (E) lesions.