Endoscopy 2009; 41: E197
DOI: 10.1055/s-0029-1214801
Unusual cases and technical notes

© Georg Thieme Verlag KG Stuttgart · New York

Rectal stenosis caused by cytomegalovirus colitis

K.  Kume1 , I.  Yoshikawa1
  • 1Third Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kitakyusyu, Japan
Further Information

K. KumeMD, PhD 

Third Department of Internal Medicine
University of Occupational and Environmental Health, School of Medicine

1-1 Iseigaoka
Yahatanishi-ku
Kitakyusyu 807-8555
Japan

Fax: +81-93-692-0107

Email: k-kume@med.uoeh-u.ac.jp

Publication History

Publication Date:
27 July 2009 (online)

Table of Contents

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.

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Fig. 1 Colonoscopy showing multiple superficial ulcerations in the rectum, 3 – 6 mm in size.

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Fig. 2 Colonoscopy with indigo carmine stain revealed shallow ulcerations with sharp margins in the rectum.

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Fig. 3 Colonoscopy after 2 months showing pinpoint stenosis as a result of scarring of ulcers at the rectosigmoid junction.

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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

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Reference

  • 1 Teixidor H T, Honing C L, Norsoph E. et al . Cytomegalovirus infection of the alimentary canal: radiologic findings with pathologic correlation.  Radiology. 1987;  163 317-323
  • 2 Cheung A N, Ng I O. Cytomegalovirus infection of the gastrointestinal tract in non-AIDS patients.  Am J Gastroenterol. 1993;  88 1882-1886
  • 3 Grobler S P, Hosie K B, Affie E. et al . Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn's disease.  Gut. 1993;  34 1384-1388
  • 4 Gumaste V, Sachar D B, Greenstein A J. Benign and malignant colorectal strictures in ulcerative colitis.  Gut. 1992;  33 938-941

K. KumeMD, PhD 

Third Department of Internal Medicine
University of Occupational and Environmental Health, School of Medicine

1-1 Iseigaoka
Yahatanishi-ku
Kitakyusyu 807-8555
Japan

Fax: +81-93-692-0107

Email: k-kume@med.uoeh-u.ac.jp

#

Reference

  • 1 Teixidor H T, Honing C L, Norsoph E. et al . Cytomegalovirus infection of the alimentary canal: radiologic findings with pathologic correlation.  Radiology. 1987;  163 317-323
  • 2 Cheung A N, Ng I O. Cytomegalovirus infection of the gastrointestinal tract in non-AIDS patients.  Am J Gastroenterol. 1993;  88 1882-1886
  • 3 Grobler S P, Hosie K B, Affie E. et al . Outcome of restorative proctocolectomy when the diagnosis is suggestive of Crohn's disease.  Gut. 1993;  34 1384-1388
  • 4 Gumaste V, Sachar D B, Greenstein A J. Benign and malignant colorectal strictures in ulcerative colitis.  Gut. 1992;  33 938-941

K. KumeMD, PhD 

Third Department of Internal Medicine
University of Occupational and Environmental Health, School of Medicine

1-1 Iseigaoka
Yahatanishi-ku
Kitakyusyu 807-8555
Japan

Fax: +81-93-692-0107

Email: k-kume@med.uoeh-u.ac.jp

Zoom Image

Fig. 1 Colonoscopy showing multiple superficial ulcerations in the rectum, 3 – 6 mm in size.

Zoom Image

Fig. 2 Colonoscopy with indigo carmine stain revealed shallow ulcerations with sharp margins in the rectum.

Zoom Image

Fig. 3 Colonoscopy after 2 months showing pinpoint stenosis as a result of scarring of ulcers at the rectosigmoid junction.

Zoom Image

Fig. 4 Barium enema after 2 months showing pinpoint stenosis as a result of scarring of ulcers at rectosigmoid junction.