Cytomegalovirus-associated panenteritis in an immunocompetent 60-year-old woman treated with oral valganciclovir: a case report

Abstract

Cytomegalovirus (CMV) infection typically affects immunocompromised individuals. However, CMV-associated enteritis involving the entire small intestine is rare in immunocompetent patients. We report a case of a 60-year-old immunocompetent woman with a history of diabetes mellitus who presented with diarrhea for 3 weeks. Abdominal computed tomography and stool tests revealed panenteritis accompanied by protein-losing enteropathy. Enteroscopy revealed ulcerative mucosa throughout the small intestine, and subsequent biopsies confirmed CMV-associated enteritis. Initial treatment with intravenous ganciclovir was complicated by pancytopenia, leading to its discontinuation and a switch to oral valganciclovir. This adjustment led to significant clinical improvement and symptom resolution. This case highlights the importance of considering CMV-associated enteritis in immunocompetent patients presenting with unexplained gastrointestinal symptoms and demonstrates the effectiveness of oral valganciclovir following ganciclovir-induced pancytopenia.

Keywords: Cytomegalovirus; case report; enteritis; ganciclovir; immunocompetent; pancytopenia; valganciclovir.

Figure 1.

Coronal views of the abdominal computed tomography image demonstrating diffuse wall thickening and mucosal enhancement throughout the entire small intestine, consistent with panenteritis.

Figure 2.

Enteroscopic images of the small intestine. The upper two images depict the jejunum, revealing diffuse hyperemic, edematous, and friable erosive mucosa with easy contact bleeding. The lower two images depict the ileum, revealing diffuse hyperemia and a significant amount of exudate. These findings are consistent with severe inflammatory changes throughout the small intestine.

Figure 3.

The upper image at ×20 magnification presents hematoxylin and eosin staining of the mucosa, revealing ulcerative changes and infiltration of numerous inflammatory cells. The yellow arrows indicate owl’s eye inclusions, which are cytopathic changes characteristic of CMV infection. The lower image at ×10 magnification presents the results of immunohistochemistry for CMV, highlighting CMV-infected cells as dark brown as dark brown stained cells. CMV, cytomegalovirus.