Lower gastrointestinal bleeding due to cytomegalovirus ileal ulcers in an immunocompetent man

Cytomegalovirus (CMV) infections are commonly reported in severely immunoco mpromised hosts and ulcers of the alimentary tract are frequently observed in systemic CMV infections. However, invasive and ulcerative disease of the gastrointestinal (GT) tract caused by CMV has also been reported in health y adults. Many reports show that a CMV infection can produce localized ulce rations in the esophagus, stomach, small intestine, and colon in nonimmunoc ompromised individuals. The most common site of involvement by CMV infectio n in the GI tract is the colon followed by the upper GI tract and the least common site is the small intestine. Although GI bleeding is one of the maj or presenting symptoms of patients with CMV infections of the GI tract, low er GI bleeding due to CMV ileal ulcers in immunocompetent patients, to our knowledge, has not been reported in the English literature. Recently, we ex perienced a case of lower GI bleeding due to CMV ileal ulcers in a 57-year- old man who had no evidence of immunocompromise. This case suggests that sm all intestinal ulcers due to CMV infection should be included in the differ ential diagnosis of lower GI bleeding even in immunocompetent hosts.