Disseminated fatal human cytomegalovirus disease after severe trauma

Objective: Disseminated human cytomegalovirus (HCMV) disease is considered to be uncommon in critically ill but otherwise not immunosuppressed patient s. We describe the case of a trauma victim who developed fatal HCMV disease that initially presented as pseudomembranous colitis and resulted in sudde n cardiac death, Design:Case report of fatal HCMV disease in a previously healthy patient af ter multiple trauma. Setting: Surgical intensive care unit (ICU). Patient A 63-yr-old male patient with multiple injuries, Interventions and Measurements: Under ICU treatment, symptoms of HCMV react ivation presenting as pseudomembranous colitis appeared 32 days after traum a. Detailed laboratory examinations for HCMV infection were performed, incl uding complement fixation titer, immunoglobulin G and M, polymerase chain r eaction, and virus isolation. Results:The intravital detection of HCMV DNA in serum, leukocytes, and a co lonic biopsy specimen indicated HCMV reactivation, Postmortem examination f indings, including positive viral cultures, showed severe disseminated HCMV disease with involvement of the colon and myocardium, Conclusions: The lack of specific clinical symptoms of HCMV disease and the delay until viral culture results are available make an exact and timely d iagnosis of HCMV disease difficult. Its prevalence in critically ill but ot herwise not immunosuppressed patients is currently unknown and possibly und erestimated, Because severe illness or trauma can cause immunodysfunction a nd, thus, may contribute to an increased rate of HCMV disease, detailed stu dies are warranted to evaluate the real risk in the ICU setting.