Filiform Polyposis (A Rare Form of Pseudopolyps) with Co-existing Cytomegalovirus Infection in a Case of Ulcerative Colitis

Filiform Polyposis (FP) is a rare form of pseudopolyps, occurring most commonly in the large intestine. It usually occurs as a rare complication of inflammatory bowel disease (Crohn’s disease or, more commonly, ulcerative colitis). But it can also occur in other chronic inflammatory or infectious diseases affecting the large bowel. Most common locations are the rectum and sigmoid colon for FP, but they can involve any length of the large intestine. They can occur as finger-like projections, sometimes with interconnections and can affect the entire colonic mucosa in a diffuse manner. Colonoscopy is the usual and most common modality for diagnosis. They are known to occur as a reparative process to chronic inflammatory conditions affecting the bowel. Inflammatory Bowel Disease (IBD) patients harbouring Cytomegalovirus (CMV) infection can also predispose the colonic mucosa to develop FP. Management usually depends on the symptoms. Surgical management is restricted in cases of complications like intestinal obstruction or bleeding and pain. Here, we report a case of a 55-year-old male with pre-existing ulcerative colitis with co-existing CMV infection, now presenting with severe intestinal obstruction. Colonoscopy revealed many polypoidal projections involving the rectum and sigmoid colon, following which he underwent subtotal colectomy. The colon specimen histopathologically revealed to have multiple interconnecting polypoidal projections lined by normal colonic mucosa with areas of chronic inflammatory changes, which was confirmed to be FP in a known case of ulcerative colitis. Though FP has no malignant potential, it can lead to intestinal obstruction and other complications, making routine follow-up necessary for patients with IBD.