Cytomegalovirus Colitis Leading to Recto-vaginal Fistula in Immunocompetent Patien

Shrikant D Pande^1, , Sherry H Y Young¹, Ramesh Wijaya¹, Seow Yen Tan¹, Aye Aye Khine¹ and May Myat Win¹

¹Changi General Hospital, Singapore

Cite this paper

Shrikant D Pande, Sherry H Y Young, Ramesh Wijaya, Seow Yen Tan, Aye Aye Khine and May Myat Win. Cytomegalovirus Colitis Leading to Recto-vaginal Fistula in Immunocompetent Patien. American Journal of Medical Case Reports. 2021; 9(1):75-77. doi: 10.12691/AJMCR-9-1-19

Abstract

Cytomegalovirus (CMV) is a double-stranded DNA virus member of Herpesviridae family. Majority of the population is exposed to CMV, based on sero-prevalence. CMV establishes latent infection and may re-activate later and cause significant clinical manifestations, especially in immunocompromised patients, like those on immunosuppressant drugs and chemotherapy, post organ transplantation and acquired immunodeficiency syndrome. The clinical manifestations of CMV in immunocompetent people are due to primary infection and vary from mild and self-limiting to severe and debilitating. CMV colitis in immune-competent people is uncommon. The complication of CMV infection leading to colonic perforation and recto-vaginal fistula is rare in immunocompetent subjects. We report case 67 year old female who was admitted with road traffic accident with tibia and T10 vertebral fracture without any abdominal injury. She underwent spinal fixation. She later developed diarrhea with abdominal pain. Whilst investigations were underway, she developed signs of intestinal obstruction. Urgent CT scan of abdomen and pelvis confirmed intestinal obstruction with rectal perforation. Urgent laparotomy was done which confirmed diagnosis of recto-vaginal iula. Adhesiolysis and Hartmann¡¯s procedure was performed. Intraoperative biopsy specimen of the rectum confirmed the diagnosis of CMV. She recovered after undergoing rehabilitation and treatment with Ganciclovir. She is awaiting reversal of colostomy.

Keywords

CMV, fistula, immunocompetent, immunocompromised

Copyright

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References

[1]	Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J, 2008; 5:47.
[2]	Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A. Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci. 2005; 50: 609-16.
[3]	Karakozis S, Gongora E, Caceres M, Brusn E, Cook J W. Life-threatening cytomegalovirus colitis in the immunocompetent patients: report of the a case and review of the literature. Dis Colon Rectum.2001; 44:1716-20.
[4]	Patra S, Samal SC, Chacko A, Mathan VI, Matham MM. Cytomegalovirus infection of the human gastrointestinal tract. J Gastroenetro Hepatol. 1999; 14:973-6.
[5]	A.L. Goodman, C.D.Murray, J Watkins et.al. CMV in the gut: a critical review of CMV detection in the immunocompetent host with colitis. Eur J Clin Microbiol Infect Dise. 2015; 34:13-18.
[6]	Gill RS, Taylor G, Penner RM, et al. Enterocolic fistula: a rare presentation of cytomegalovirus infection. Can J Infect Dis Med Microbiol. 2012; 23:0.
[7]	Boru, ML.Cytomegalovirus infection causing an enterocitaneous fistula in a patient with acquired immunodeficiency syndrome. Dig Dis Sci.1997; 42:2603-2605.
[8]	Asif T, Hasan B, Likhitsup A, Bamberger D. Colovesical fistula: An Unusual Complication of Cytomegalovirus Colitis. Cureus. 2017 Jul5; 9(7):e1426.
[9]	Rao S, Pande S D, Hussain R, Ang D, Seah J. Clinical Presentations of Cytomegalovirus Infection in Immunocompetent Hosts. Journal of Tropical Diseases. October. 2018.