Cytomegalovirus enteritis causing multifocal ileal perforation in a patient with chronic lymphocytic leukaemia: a case report

Gabrielle L. Matthews; Scott Bethune; Lyndon Nofz

doi:10.18203/2349-2902.isj20263361

Authors

Gabrielle L. Matthews Department of General Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia
Scott Bethune Royal Brisbane and Women's Hospital, Queensland, Australia
Lyndon Nofz Department of General Surgery, Royal Brisbane and Women's Hospital, Queensland, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20263361

Keywords:

Cytomegalovirus enteritis, Small bowel perforation, Chronic lymphocytic leukaemia, Ganciclovir, Immunocompromised host, Case report

Abstract

Cytomegalovirus (CMV) infection of the gastrointestinal tract occurs predominantly in immunocompromised patients and most commonly affects the stomach and colon, while clinically significant small bowel disease and perforation are rare. We report a case of a 79-year-old man with chronic lymphocytic leukaemia (CLL), developing a superimposed CMV infection leading to hollow viscus perforation. CMV inclusions were confined to ulcerated mucosa overlying areas of neoplastic infiltration and were absent in intervening macroscopically normal bowel, supporting a synergistic clinicopathological mechanism rather than incidental co-infection. This case highlights that in immunocompromised patients with multifocal bowel thickening and perforation, CMV enteritis should be considered even when preoperative imaging suggests an alternative source.

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