# Cytomegalovirus-Induced Colitis Presenting as Acute Appendicitis in an Immunocompetent Patient With Ulcerative Colitis

## TL;DR

A 71-year-old man with ulcerative colitis showed symptoms of acute appendicitis, but was diagnosed with cytomegalovirus (CMV) colitis through colonoscopy.

## Contribution

This case highlights a rare presentation of CMV colitis mimicking acute appendicitis in an immunocompetent patient.

## Key findings

- CMV colitis was diagnosed in a patient with ulcerative colitis despite an initial radiological diagnosis of acute appendicitis.
- The patient was immunocompetent, which is unusual for CMV reactivation cases.
- Colonoscopy was crucial for accurate diagnosis after antibiotic treatment failed.

## Abstract

We report a rare case of cytomegalovirus (CMV) colitis presenting radiologically as acute appendicitis in an immunocompetent 71-year-old man known for ulcerative colitis. Although initial imaging revealed acute appendicitis, a lack of clinical improvement with antibiotic therapy prompted further evaluation with colonoscopy, which led to the diagnosis of CMV colitis on a background of mild ulcerative colitis flare. Most individuals infected by CMV will exhibit lifelong latency; however, the virus can reactivate under impaired immune status (eg, transplant recipients, those receiving immunosuppressive therapy). Patients with underlying inflammatory bowel disease are especially at risk of CMV colitis during an acute flare. This case illustrates a unique presentation of CMV colitis in an immunocompetent host, with initial imaging studies revealing acute appendicitis.