Generalised intestinal CMV infection with protein losing syndrome in ulcerative colitis

Infection by cytomegalovirus (CMV) in immunocompetent patients is rare, and if it occurs it is most often associated with ulcerative colitis. This cas e illustrates a CMV infection in a patient with an ulcerative colitis combi ned with CMV-induced protein losing enteropathy, a condition reported in im munocompetent individuals in only a very few cases worldwide. It demonstrat es the importance of differentiating between a flare-up of ulcerative colit is and CMV colitis. The indication for antiviral therapy is discussed. A 76-years-old patient with a 23-year history of leftsided ulcerative colit is presented with acute pancolitis sparing the rectum. He showed no evidenc e of impaired host defence, nor has he ever had taken immunosuppressive dru gs. Disseminated primary CMV infection involving of the colon, the oesophag us and the small intestine with protein losing enteropathy was diagnosed on the basis of histology, culture and serology. In view of the long duration of the illness and the highly active infection, antiviral therapy with gan ciclovir was given and led to a dramatical improvement of all disease manif estations. The patient subsequently remained in remission from ulcerative c olitis for three years.