title: A rare case intractable diarrhea secondary to Clostridium difficile and cytomegalovirus coinfection.
abstract: METHODS
  Male, 63 FINAL DIAGNOSIS: Cytomegalo virus (CMV) infection Symptoms: Diarrhea Medication:- Clinical Procedure:- Specialty: Infectious Diseases.
  
  
  OBJECTIVE
  Unusual clinical course.
  
  
  BACKGROUND
  Coinfection with cytomegalovirus in a patient with Clostridium difficile persistent diarrhea and colitis can lead to a delay in diagnosis and treatment.
  
  
  METHODS
  A 63-year-old man with squamous cell carcinoma of the lower lip, status post surgical resection and currently on chemoradiation presented with intractable diarrhea and abdominal pain. Initial workup showed Clostridium difficile diarrhea with pancolitis. Diarrhea persisted despite being on antibiotics and bacteriological cure for C. difficile. Further noninvasive work up revealed associated cytomegalovirus infection, and patient had a dramatic response to ganciclovir without any relapse.
  
  
  CONCLUSIONS
  Physicians should be cognizant about other causes of diarrhea and colitis in immunocompromised patient when treatment for primary diagnosis fails to resolve their symptoms.
authors.affiliation: Department of Internal Medicine, University of Arizona College of Medicine, Tucson, AZ, U.S.A.
authors.forename: Santhosh Gheevarghese
authors.initials: SG
authors.lastname: John
authors.forename: Cristian
authors.initials: C
authors.lastname: Dominguez
authors.forename: Vijay
authors.initials: V
authors.lastname: Chandiramani
authors.forename: Tejo
authors.initials: T
authors.lastname: Vemulappalli
keywords: Clostridium difficile; coinfection; cytomegalovirus; intractable diarrhea; pancolitis