HIV-ASSOCIATED CYTOMEGALOVIRUS COLITIS AS A MIMIC OF INFLAMMATORY BOWEL-DISEASE

Cytomegalovirus (CMV) colitis may cause symptoms and signs identical t o those of idiopathic inflammatory bowel disease. Although difficult t o diagnose with certainty, the histological finding of cytomegalovirus inclusions in tissue from a case of suspected inflammatory bowel. dis ease is strongly suggestive. CMV colitis is an entity almost entirely confined to cases of severe immunosuppression. The case of a 79 year o ld widower who was admitted to hospital with symptoms suggestive of in flammatory bowel disease is presented. Despite medical treatment his c ondition worsened and he developed toxic dilatation of the colon requi ring colectomy. Histological examination showed a mild superficial pan colitis, with focal severe inflammation, deep fissuring ulceration, an d pseudopolyposis. Abundant CMV inclusions were seen in cells associat ed with the ulcerating inflammatory tissue. A diagnosis of indetermina te colitis with CMV was made. The patient's condition worsened after s urgery and he died a few days later despite intensive treatment, inclu ding antiviral chemotherapy directed against CMV. After death HIV sero logy was found to be Regardless of the age and lifestyle of the patien t, a diagnosis of CMV colitis in someone not known to be immunosuppres sed raises the possibility of HIV infection.