Severe proctitis, perforation, and fatal rectal bleeding secondary to cytomegalovirus in an immunocompetent patient: report of a case.
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.
Alam
Imran
I
Department of Surgery, Morriston Hospital, Swansea, SA6 6NL, UK.
Shanoon
Divina
D
Alhamdani
Ali
A
Boyd
A
A
Griffiths
A P
AP
Baxter
J N
JN
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*