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cytomegalovirus colitis; CMV colitis
Etiology:
- cytomegalovirus infection in patients with HIV1 infection/AIDS
- generally due to reactivation of latent virus
- complication of refractory ulcerative colitis
Epidemiology:
- CMV is the most common opportunistic pathogen causing colitis
Pathology:
- colonic ulcerative lesions with intranuclear inclusions
- clean-based colonic ulcers
Clinical manifestations:
- tenesmus, proctitis, abdominal pain, frequent small volume bowel movements
- bloody diarrhea in patients with refractory ulcerative colitis
Laboratory:
- CD4 count < 50-100/uL
- a negative cytomegalovirus IgG in serum renders CMV colitis unlikely*
* CMV colitis is generally due to reactivation of latent virus
Special laboratory:
- colonoscopy
- sigmoidoscopy with biopsy for refractory ulcerative colitis
- ophthalmoscopy for CMV retinitis in patients with HIV1 infection & cytomegalovius infection
Differential diagnosis:
- cryptosporidiosis: large volume watery diarrhea
- giardiasis: large volume watery diarrhea
- Mycobacterium avium complex:
- fever, diarrhea (see HIV1-associated diarrhea)
- no tenesmus, proctitis, ulcers
- elevated alkaline phosphatase in serum
- CD4 count < 50/uL
- ulcerative colitis:
- rare in AIDS patients
- disease may be more quiescent in HIV1 patients with CD4 count < 50/uL
- Kaposi sarcoma: submucosal hemorrhagic lesions, rarely symptomatic
Treatment:
- ganciclovir (see Cytomegalovirus)
General
diarrhea in patients with AIDS
cytomegalovirus (CMV, human herpesvirus 5, HHV5)
colitis
References
- NEJM Knowledge+ Gastroenterology