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Rare disease
CASE REPORT
Recurrent cytomegalovirus colitis: a rare case of immune reconstitution inflammatory syndrome
  1. Joseph Alukal1,
  2. Mohammed Asif2,
  3. Rachana Mundada3,
  4. William B McNamee4
  1. 1Department of Internal Medicine, Mercy Fitzgerald Hospital, Darby, Pennsylvania, USA
  2. 2Department of Surgery, Mercy Fitzgerald Hospital, Darby, Pennsylvania, USA
  3. 3Department of Internal Medicine, Mercy Fitzgerald Hospital, Darby, Pennsylvania, USA
  4. 4Department of Internal Medicine-Infectious Disease, Mercy Fitzgerald Hospital, Darby, Pennsylvania, USA
  1. Correspondence to Dr Mohammed Asif, mohammedasifmd12{at}gmail.com

Summary

Cytomegalovirus (CMV) colitis usually occurs in patients with advanced immunosuppression when the CD4 count is <50 cells/μL. We reported a case of recurrent CMV colitis in a patient with HIV who presented with profuse lower gastrointestinal bleed. This was a case of immune reconstitution inflammatory syndrome (IRIS) manifesting as CMV colitis and has been reported only once in the literature previously. This patient had a CD4 count of 157 cells/μL and undetectable viral load after being on antiretroviral therapy (ART) for 5 months, which was consistent with IRIS. The diagnosis of CMV was confirmed by a colonoscopy and a biopsy. This case highlights the fact that CMV colitis can manifest despite a moderately preserved CD4 count and the clinicians must have a high index suspicion for IRIS syndrome especially when someone was recently started on ART. Since effective treatment is available, it is important not to miss the diagnosis of CMV colitis.

  • gastroenterology
  • endoscopy
  • ulcer
  • infection (gastroenterology)
  • Hiv / Aids

https://doi.org/10.1136/bcr-2017-221121

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    Footnotes

    • Contributors JA is responsible for planning, conduct, reporting, conception and design, acquisition of data or analysis and interpretation of data, writing and reviewing the manuscript. MA is responsible for design, acquisition of data or analysis and interpretation of data, writing and reviewing the manuscript. RM and WBM are responsible for writing and reviewing the manuscript.

    • Competing interests None declared.

    • Patient consent Obtained from next of kin.

    • Provenance and peer review Not commissioned; externally peer reviewed.