Colon perforation with peritonitis in an acquired immunodeficiency syndrome patient due to cytomegalovirus and amoebic colitis.
Invasive amoebiasis is rarely seen in human immunodeficiency virus (HIV)-infected individuals, even in endemic areas. By contrast, cytomegalovirus (CMV) disease is recognized as a major clinical problem in acquired immunodeficiency syndrome patients. A 34-year-old HIV-infected man with amoeba colitis, disseminated Mycobacterium avian complex and CMV infection with cecum perforation, presented with the initial symptoms of fever, shortness of breath and painful sensation when swallowing. He was treated with fluconazole, trimethoprim-sulfamethoxazole and hydrocortisone under the impression of esophageal candidiasis and Pneumocystis jiroveci pneumonia. However, diarrhea and abdominal pain developed on day 6 of hospitalization. Invasive amoebiasis and CMV colitis was diagnosed after examination of colon pathological specimens. Emergent laparotomy was performed. Right hemicolectomy with double barrel ileostomy and colostomy was done due to perforation of the cecum. Iodoquinol was given, followed by metronidazole 14 days afterwards. He underwent closure of double barrel ileostomy and colostomy 5 months later. This case illustrates the diagnostic challenge of caring for acquired immunodeficiency syndrome persons with multiple illnesses and medication use. CMV infection, amoebic colitis and possibly corticosteroid may have played a role in colon perforation in our patient.
Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, and National Yang-Ming University, Taipei, Taiwan.
Hung-Chin
HC
Tsai
Susan Shin-Jung
SS
Lee
Shue-Ren
SR
Wann
Yao-Shen
YS
Chen
Eng-Rin
ER
Chen
Chuan-Min
CM
Yen
Yung-Ching
YC
Liu
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D000328:Adult; D003108:Colonic Diseases / Q000209:etiology*; D003586:Cytomegalovirus Infections / Q000150:complications*; D004404:Dysentery, Amebic / Q000150:complications*; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology*; D008297:Male; D010538:Peritonitis / Q000209:etiology*