A solitary rectal ulcer in an elderly patient

A 92 year old female with multiple co-morbidities was admitted following a fall at home. She was found to be suffering from ongoing loose stool with intermittent rectal bleeding during hospitalisation. An inpatient flexible sigmoidoscopy identified a large well-demarcated, superficial, non-bleeding ulcer in the rectum. Histology of biopsies of the rectal ulcer showed inflammation and ulceration with crypt distortions in the ulcer base. Immunohistochemistry for cytomegalovirus (CMV) confirmed presence of inclusion bodies which was suggestive of CMV proctitis. Her CMV IgG serology was positive with a high DNA level of 15,861 IU/mL. Oral valganciclovir was started and patient responded well to the anti-viral treatment with resolving bowel symptoms.