Cytomegalovirus Colitis in an End-Stage Renal Disease Patient Presenting with Lower Gastrointestinal Bleeding
Asawin Sudcharoen MD*, Piyanant Chonmaitree MD*, Piyakorn Poonyam MD*, Therdkiat Trongwongsa MD**
Affiliation : * Department of Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand ** Department of Pathology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
The authors report a case of cytomegalovirus colitis which is one of uncommon causes of lower gastrointestinal bleeding in a patient with end-stage renal disease receiving hemodialysis. Our patient presented with recurrent episodes of massive hematochezia within 2 months. He had the underlying end-stage renal disease, ischemic heart disease, cerebrovascular disease, hypertension and gout. Colonoscopy revealed multiple clean base ulcers at rectum and sigmoid colon. An active bleeding lesion was rectal ulcer with non bleeding visible vessel which was successfully treated with hemoclipping. The diagnosis of cytomegalovirus colitis was confirmed by pathology from colonic tissues which showed compatible patterns of cytopathic change. Human immunodeficiency virus serology was negative. He was treated with with ganciclovir intravenously for 1 week after the pathological finding was reported. To our knowledge, cytomegalovirus infection should be considered as causative pathogen of colitis and colonic ulcers in end-stage renal disease patients.
Keywords : Cytomegalovirus, Colitis, Colonic ulcer, Lower gastrointestinal bleeding
