CMV Colitis in a Systemic Lupus Disease Patient: Case Report and Review

Introduction: Cytomegalovirus (CMV) infections are common, particularly among immunocompromised patients. They are usually asymptomatic, but can be responsible for severe symptoms and complications especially in immunocompromised individuals including those with human immunodeficiency virus infection or receiving long-term treatments with corticosteroids or immunosuppressive therapy. CMV colitis is the second most common presentation of end-organ disease. Case presentation: We report the case of a 27-year-old female patient, followed since the age of 15 for systemic lupus with cutaneous, articular, hematological and grade 4 renal impairment, on long-term corticosteroid therapy, mycophenolate mofetil (MMF) and hydroxychloroquine, admitted to hospital for altered general condition, generalized muscle weakness, and hematochezia. Clinical examination on admission revealed generalized mucocutaneous pallor, right hemiparesis, and normal proctological examination. She was referred to our digestive endoscopy unit for colonoscopy. Endoscopic examination revealed the presence of 3 large ulcers in the sigmoid colon, and a subcentimetric ulcer in the right colo, with normal intercalary mucosa. Biopsies taken from the ulcer margins showed positive CMV PCR. The diagnosis of CMV colitis was thus made and the patient was put on IV Ganciglovir. Conclusion: CMV colitis could occur in lupus patient under corticosteroids or immunosuppressive therapy. It should be included in the differential diagnosis in these patients who present to emergency department with bloody stools, acute abdominal pain or diarrhea.