Intest Res.  2016 Apr;14(2):187-190. 10.5217/ir.2016.14.2.187.

Pulmonary embolism in an immunocompetent patient with acute cytomegalovirus colitis

• Chou JW
• Cheng KS

• KMID: 2425293
• DOI: http://doi.org/10.5217/ir.2016.14.2.187

Abstract

Acute cytomegalovirus (CMV) infection occurs commonly in immunocompromised and immunocompetent patients, but is usually asymptomatic in the latter. Vascular events associated with acute CMV infection have been described, but are rare. Hence, such events are rarely reported in the literature. We report a case of pulmonary embolism secondary to acute CMV colitis in an immunocompetent 78-year-old man. The patient presented with fever and diarrhea. Colonic ulcers were diagnosed based on colonoscopy findings, and CMV was the proven etiology on pathological examination. The patient subsequently experienced acute respiratory failure. Pulmonary embolism was diagnosed based on the chest radiography and computed tomography findings. A diagnosis of acute CMV colitis complicated by pulmonary embolism was made. The patient was successfully treated with intravenous administration of unfractionated heparin and intravenous ganciclovir.

Keyword

Cytomegalovirus colitis; Immunocompetent; Pulmonary embolism; Vascular thrombosis

MeSH Terms

Administration, Intravenous
Aged
Colitis*
Colon
Colonoscopy
Cytomegalovirus*
Diagnosis
Diarrhea
Fever
Ganciclovir
Heparin
Humans
Pulmonary Embolism*
Radiography
Respiratory Insufficiency
Thorax
Ulcer
Ganciclovir
Heparin

Figure

• 

  Fig. 1 Endoscopic findings. Colonoscopy revealed a giant ulcer with an irregular margin and skip lesions in the distal colon.

• 

  Fig. 2 Chest X-ray findings. Chest radiograph revealed an engorged pulmonary trunk with an abrupt cutoff of pulmonary vascularity in the distal portions bilaterally, indicative of the "Westermark sign" (arrows).

• 

  Fig. 3 Chest CT finding. Chest CT scan showed filling defects within the pulmonary trunk and main pulmonary arteries (arrows).

• 

  Fig. 4 Histopathological findings. (A) Histological examination of biopsy specimens showed cytomegalic cells in the epithelium. The cells had large, densely stained nuclei and intranuclear inclusion bodies (arrows) on H&E (magnification, ×400). (B) Immunohistochemical analysis showed positive reaction for monoclonal anti-cytomegalovirus antibodies (arrows; magnification, ×400).

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