Korean J Gastroenterol.  2012 Apr;59(4):303-307. 10.4166/kjg.2012.59.4.303.

A Case of Cytomegalovirus Colitis with Endoscopic Finding Resembling Crohn's Disease

• Huh CW
• Youn YH
• Jung DH
• Kim DW
• Kho BG
• Kim JH
• Park H
• Lee SI

• KMID: 1364834
• DOI: http://doi.org/10.4166/kjg.2012.59.4.303

Abstract

Cytomegalovirus (CMV) colitis is common among immunocompromised patients, and often diagnosed by pathologic confirmation because it is associated with a diverse spectrum of clinical and endoscopic features. However, Crohn's disease has no definitive diagnostic criteria, but longitudinal ulcers and cobble stone appearance are accepted as typical endoscopic features of Crohn's disease. An 83 year-old male with a history of radiotherapy for hypopharyngeal cancer visited our hospital with a complaint of melena for 1 week. His colonoscopic exam showed multiple longitudinal ulcers along the entire colon. Most of the ulcers were longer than 4 cm, these endoscopic findings were suspected as typical endoscopic features of Crohn's disease. Pathologic reports revealed multiple inclusion bodies with CMV on immunohistochemistry. He was finally diagnosed as having CMV colitis, and received a 3 week-course of intravenous ganciclovir. A colonoscopic follow-up showed complete healing of the multiple longitudinal ulcers, and he is doing well now without further treatment.

Keyword

Cytomegalovirus colitis; Longitudinal ulcer; Crohn's disease

MeSH Terms

Aged, 80 and over
Antiviral Agents/therapeutic use
Colitis/*diagnosis/etiology/pathology
Colonoscopy
Crohn Disease/diagnosis
Cytomegalovirus Infections/*diagnosis/drug therapy/pathology
Ganciclovir/therapeutic use
Humans
Immunohistochemistry
Injections, Intravenous
Male
Tomography, X-Ray Computed

Figure

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  Fig. 1 Abdominal CT findings. (A) It showed bowel wall thickening at the proximal transverse colon (arrow). (B) There were also bowel wall thickening at the splenic flexure (arrow).

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  Fig. 2 Initial colonoscopic findings. It showed multiple longitudinal shaped ulcer longer than 4 cm.

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  Fig. 3 Pathologic findings. (A) It showed giant cell with intranuclear cytomegalic inclusion body (arrow; H&E, ×400). (B) It showed positive reaction to cytomegalovirus monoclonal antibody (immunohistochemical stain, ×400).

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  Fig. 4 Follow up colonoscopic finding 5 weeks after initial colonoscopy. It showed complete healing of previous longitudinal ulcers and red longitudinal scars only.

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