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. 2020 Sep 2;7(10):001911.
doi: 10.12890/2020_001911. eCollection 2020.

COVID-19 and Cytomegalovirus Co-infection: A Challenging Case of a Critically Ill Patient with Gastrointestinal Symptoms

Pedro Hf Amaral  1 , Bernadete Mc Ferreira  2 , Sergio Roll  1 , Precil Dmm Neves  2 , Luca Ga Pivetta  1 , Sara Mohrbacher  2 , Eduardo Rm Dias  1 , Victor Ah Sato  2 , Érico S Oliveira  2 , Leonardo Vb Pereira  2 , Alessandra M Bales  2 , Luciana L Nardotto  2 , Jéssica N Ferreira  2 , Américo L Cuvello-Neto  2 , Pedro R Chocair  2
Affiliations

COVID-19 and Cytomegalovirus Co-infection: A Challenging Case of a Critically Ill Patient with Gastrointestinal Symptoms

Pedro Hf Amaral et al. Eur J Case Rep Intern Med. .

Abstract

COVID-19 is a severe disease that has reached pandemic status. To the best of our knowledge, we describe the first case of COVID-19 and cytomegalovirus (CMV) co-infection in a critically ill patient. We discuss the challenge of establishing the diagnosis as well as the management of tissue-invasive gastrointestinal CMV infection (TI-GI CMV) simulating vascular involvement and intestinal obstruction in a critically ill patient.

Learning points: We describe a case of COVID-19 and cytomegalovirus (CMV) co-infection in a critically ill patient.Clinical symptoms simulated mesenteric vascular involvement and intestinal obstruction.The successful management of invasive CMV colitis in a patient with COVID-19 with atypical symptoms is described.

Keywords: COVID-19; Colitis; cytomegalovirus; immunosuppression; intensive care unit.

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Conflict of interest statement

Conflicts of Interests: The Authors declare that there are no competing interests.

Figures

Figure 1
Figure 1
(A,B) Computed tomography scan of the abdomen revealed jejunal thickening with no evidence of mesenteric ischaemia. (C) Colonoscopy findings showed an extensive ulcerated area, measuring about 5.0 cm, affecting 80% of the ileum circumference. (D) Biopsy of the ileum revealing extensive ulceration with fibrino-leucocytic exudate and endothelial cells with viral cytopathic changes (black arrows, ×400). (E) Immunohistochemistry for cytomegalovirus showed positive staining in several cells (black arrows, ×100)
See this image and copyright information in PMC

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