Cytomegalovirus colitis in a human immunodeficiency virus seropositive individual with moderately severe immunodeficiency

Colitis is the most common extraocular manifestation of cytomegalovirus (CMV) infection in human immunodeficiency virus (HIV) infected patients. CMV disease is usually seen in HIV-infected patients with CD4+ counts less than 50/ mm 3 . There are documented reports of CMV gastrointestinal disease in patients with CD4+ count greater than 50 cells/L. A 46-year-old man with HIV1 infection on irregular antiretroviral treatment presented with low grade fever, abdominal pain and vomitings. He is a known alcoholic. Physical examination revealed pallor, evidence of malnutrition and tenderness in the abdomen. Laboratory investigations revealed mild anaemia; CD4+ count was 240 cells/L. Fundus examination of the patient was normal. Contrast enhanced computed tomography (CECT) of the abdomen revealed dilated small bowel loops, thickening of wall of splenic flexure and thickening of caecal and terminal ileal wall with mild narrowing. As anti-CMV antibodies (IgM) and CMV real time-polymerase chain reaction (PCR) tested positive, patient was treated with intravenous ganciclovir for 14 days followed by oral valganciclovir and patient showed remarkable improvement. Our case highlights the fact that CMV colitis can also occur in patients with relatively preserved CD4+ counts especially if co-morbid conditions like alcoholism co-exist.