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Case Reports
. 2025 Jul 21;12(7):e01768.
doi: 10.14309/crj.0000000000001768. eCollection 2025 Jul.

Cytomegalovirus Enteritis: A Rare Culprit of Protein Losing Enteropathy in an Immunocompetent Adult

Nancy Mayer  1 , Vijay Kata  1 , Dhaval Patel  2 , Daniel Errampalli  2 , Thomas O'Connor  2 , Matthew Kaplan  2 , Thomas Betlej  3 , Nikhil Bhargava  2
Affiliations
Case Reports

Cytomegalovirus Enteritis: A Rare Culprit of Protein Losing Enteropathy in an Immunocompetent Adult

Nancy Mayer et al. ACG Case Rep J. .

Abstract

Protein-losing enteropathy (PLE) is a rare complication of cytomegalovirus (CMV) enteritis in immunocompetent individuals. We present a case of a previously healthy 60-year-old woman with an acute CMV infection, manifesting as intractable vomiting and diarrhea, refractory electrolyte disturbances, and anasarca. The diagnostic evaluation showed low serum protein levels and an increased fecal alpha-1 antitrypsin clearance, confirming PLE. CMV-specific immunohistochemistry on duodenal samples subsequently confirmed that the PLE was caused by CMV enteritis. She completed treatment with valganciclovir for 3 weeks, resulting in symptom resolution and normalization of endoscopic findings. This case highlights the importance of recognizing CMV-associated PLE, particularly in immunocompetent individuals, for timely diagnosis and treatment.

Keywords: CMV enteritis; alpha-1 antitrypsin clearance; cytomegalovius; duodenitis; immunocompetent host; protein-losing enteropathy.

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Figures

Figure 1.
Figure 1.
Erythema, erosions, friability, white plaques, ulceration, and scalloped folds in the whole examined duodenum compatible with ulcerative duodenitis.
Figure 2.
Figure 2.
Immunohistochemical staining demonstrating cytomegalovirus-positive cells within the duodenal lamina propria (original magnification ×400).
Figure 3.
Figure 3.
Mild erythema of the duodenum after valganciclovir treatment.
See this image and copyright information in PMC

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