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

BMJ Case Rep. 2016 Jul 20:2016:bcr2015214196. doi: 10.1136/bcr-2015-214196.

Abstract

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/mm(3) 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.

Publication types

  • Case Reports

MeSH terms

  • AIDS-Related Opportunistic Infections / microbiology*
  • Acquired Immunodeficiency Syndrome / complications*
  • Cytomegalovirus Infections / complications*
  • Cytomegalovirus Retinitis / complications
  • Fatal Outcome
  • Humans
  • Intestinal Perforation / microbiology*
  • Male
  • Middle Aged
  • Recurrence