Cytomegalovirus Colitis Masquerading as a Recurrent Colonic Polyp in a Patient With Neurofibromatosis Type 1

Abstract

Cytomegalovirus colitis most commonly affects immunocompromised patients, although it is a rare cause of gastrointestinal bleeding in immunocompetent patients. Older age, chronic disease, and critical illness are also important risk factors and may lead providers to consider the diagnosis in otherwise immunocompetent patients. Endoscopic presentation is variable and does not significantly influence outcomes. Although most immunocompetent, noncritically ill patients improve with or without antiviral treatment, mortality rates are as high as 71.4% in critically ill patients. Such mortality rates necessitate that intensive care providers remain wary of the diagnosis in any patient presenting with gastrointestinal bleeding. We present a rare case of cytomegalovirus colitis masquerading as a recurrent colonic mass in a patient with neurofibromatosis type 1.

Keywords: colitis; colonic polyp; cytomegalovirus.

Figure 1.

Colonoscopy images showing a nonobstructing, frond-like, fungating, and polypoid mass at the ileocolic anastomosis, measuring 5 cm in the largest dimension.

Figure 2.

Histopathology specimens demonstrating the classic “owl's eye” appearance of CMV nuclear inclusions (A, yellow arrow, 200× original magnification, hematoxylin-eosin) and positive CMV immunostaining (B). CMV, cytomegalovirus.