title: Severe proctitis, perforation, and fatal rectal bleeding secondary to cytomegalovirus in an immunocompetent patient: report of a case.
abstract: Cytomegalovirus (CMV) infection is associated with significant morbidity and mortality in immunocompromised patients. In immunocompetent individuals, the infection is usually subclinical but it can sometimes be life threatening. We describe a case of fatal CMV proctitis in a 71-year-old man following an Ivor-Lewis esophagectomy. After surgery he developed renal failure, methicillin-resistant Staphylococcus aureus pneumonia, and acute respiratory distress syndrome. He recovered but developed melena and massive fresh rectal bleeding. Sigmoidoscopy revealed severe proctitis and a biopsy was consistent with ischemia. Despite undergoing a proctectomy he continued to bleed and died despite every effort. The final histological examination of the rectum revealed a CMV infection.
authors.affiliation: Department of Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
authors.forename: Imran
authors.initials: I
authors.lastname: Alam
authors.forename: Divina
authors.initials: D
authors.lastname: Shanoon
authors.forename: Ali
authors.initials: A
authors.lastname: Alhamdani
authors.forename: A
authors.initials: A
authors.lastname: Boyd
authors.forename: A P
authors.initials: AP
authors.lastname: Griffiths
authors.forename: J N
authors.initials: JN
authors.lastname: Baxter
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D003586:Cytomegalovirus Infections / Q000150:complications*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy; D006471:Gastrointestinal Hemorrhage / Q000821:virology*; D006801:Humans; D007121:Immunocompetence; D007416:Intestinal Perforation / Q000276:immunology / Q000821:virology*; D008297:Male; D011183:Postoperative Complications; D011349:Proctitis / Q000276:immunology / Q000821:virology*