This article reports a case of cytomegalovirus (CMV) ileitis with perf
oration in a woman with transfusion-acquired human immunodeficiency vi
rus (HIV) infection. The clinical problem of small bowel perforation d
ue to CMV disease in association with HIV infection is emphasized. Typ
ically, a patient with a history of chronic diarrhea, fever, and abdom
inal pain develops the superimposed picture of an acute abdomen and ha
s pneumoperitonium on radiograph. The prognosis is poor.