BMJ Case Reports 2016; doi:10.1136/bcr-2015-214196

Perforation of the bowel due to cytomegalovirus infection in a man with AIDS: surgery is not always necessary!

  1. Kathir G Yoganathan3
  1. 1University College London Institute of Neurology, London, UK
  2. 2Department of Surgery, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, UK
  3. 3Department of GUM/HIV, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, UK
  1. Correspondence to Dr Kathir G Yoganathan, kathir.yoganathan{at}
  • Accepted 6 June 2016
  • Published 20 July 2016


Cytomegalovirus (CMV) infection is the most common viral opportunistic infection in immunocompromised patients and is a rare cause of bowel perforation. It invariably requires surgical intervention and is often fatal. We report a 50-year-old Caucasian man with AIDS, presented 3 weeks after developing abdominal pain and distension. He was treated for CMV retinitis in the past. His adherence to antiretroviral therapy was poor. Examination revealed a recurrence of active CMV retinitis. His abdomen was tender and distended. The plain X-ray of the abdomen revealed a double wall sign (Rigler's sign), indicating pneumoperitoneum due to the bowel perforation. The upper endoscopy was normal. His CD4 count was 30 cells/mm3. He was treated with cidofovir infusion. He made a full recovery, without requiring any form of surgery. However, he died of adult respiratory distress syndrome 14 months later, due to iatrogenic acute pancreatitis.

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