title: Perforation of the bowel due to cytomegalovirus infection in a man with AIDS: surgery is not always necessary!
abstract: Cytomegalovirus (CMV) infection is the most common viral opportunistic infection in immunocompromised patients and is a rare cause of bowel perforation. It invariably requires surgical intervention and is often fatal. We report a 50-year-old Caucasian man with AIDS, presented 3 weeks after developing abdominal pain and distension. He was treated for CMV retinitis in the past. His adherence to antiretroviral therapy was poor. Examination revealed a recurrence of active CMV retinitis. His abdomen was tender and distended. The plain X-ray of the abdomen revealed a double wall sign (Rigler's sign), indicating pneumoperitoneum due to the bowel perforation. The upper endoscopy was normal. His CD4 count was 30 cells/mm(3) He was treated with cidofovir infusion. He made a full recovery, without requiring any form of surgery. However, he died of adult respiratory distress syndrome 14 months later, due to iatrogenic acute pancreatitis.
authors.affiliation: University College London Institute of Neurology, London, UK.
authors.forename: Katie Tharshana
authors.initials: KT
authors.lastname: Yoganathan
authors.affiliation: Department of Surgery, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, UK.
authors.forename: Andrew Roger
authors.initials: AR
authors.lastname: Morgan
authors.affiliation: Department of GUM/HIV, Abertawe Bro Morgannwg University Health Board, Singleton Hospital, Swansea, UK.
authors.forename: Kathir G
authors.initials: KG
authors.lastname: Yoganathan
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000382:microbiology*; D000163:Acquired Immunodeficiency Syndrome / Q000150:complications*; D003586:Cytomegalovirus Infections / Q000150:complications*; D017726:Cytomegalovirus Retinitis / Q000150:complications; D017809:Fatal Outcome; D006801:Humans; D007416:Intestinal Perforation / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D012008:Recurrence