A 87-year-old man attended our hospital for watery diarrhea since 1
week. Colonoscopy revealed multiple 3 – 6 mm
superficial ulcerations in the rectum ([Fig. 1]).
The ulcers were shallow and had sharp margins ([Fig. 2]). Cytomegalovirus (CMV) pp65 antigenemia
assay (C7-HRP; SRL Inc, Japan) revealed many CMV-positive cells (6/1400 cells).
Because CMV viremia was strongly suspected, treatment was initiated with
ganciclovir. Immunohistochemistry of biopsy specimens taken from the ulcer
craters revealed intranuclear inclusions that were positive for immunostaining
with specific anti-CMV antibodies. After 7 days, the diarrhea ceased. At
follow-up 2 months later, colonoscopy ([Fig. 3])
and barium enema ([Fig. 4]) both revealed pinpoint
stenosis at the rectosigmoid junction, related to the ulcer scars. We took this
to mean a cure in endoscopic terms.
Fig. 1 Colonoscopy showing
multiple superficial ulcerations in the rectum,
3 – 6 mm in size.
Fig. 2 Colonoscopy with indigo
carmine stain revealed shallow ulcerations with sharp margins in the
rectum.
Fig. 3 Colonoscopy after 2
months showing pinpoint stenosis as a result of scarring of ulcers at the
rectosigmoid junction.
Fig. 4 Barium enema after 2
months showing pinpoint stenosis as a result of scarring of ulcers at
rectosigmoid junction.
CMV is an important and ubiquitous herpes virus, and the
gastrointestinal tract is one of the common sites of infection
[1]. Colonoscopy in our case revealed superficial
ulcerative colitis. The pathogenesis of CMV-induced ulcerations is thought to
involve ischemic mucosal injury secondary to infection of vascular endothelial
cells [2]. In addition, it is well known that rectal
stenosis is caused by inflammatory bowel disease such as ulcerative colitis and
Crohn’s disease [3]
[4].
However, in our case, we thought that the stenosis was a result of the
circumferential location of the rectal ulcers. To our knowledge, this is the
first reported case of rectal stenosis caused by CMV colitis.
Endoscopy_UCTN_Code_CCL_1AD_2AZ
