Cytomegalovirus Proctitis Mimicking Inflammatory Bowel Disease in an Immunocompetent Elderly Patient: A Diagnostic Challenge

TL;DR

An elderly person with a healthy immune system had CMV proctitis mistaken for bowel disease, highlighting the need for early CMV testing in similar cases.

Contribution

Highlights CMV proctitis as an underrecognized cause of bloody diarrhea in immunocompetent elderly patients.

Findings

CMV proctitis was diagnosed in an immunocompetent elderly patient after initial tests were negative.

Refractory colitis in the elderly may be due to CMV proctitis, which is often overlooked.

Early detection can prevent unnecessary immunosuppressive therapy and prolonged illness.

Abstract

Cytomegalovirus (CMV) colitis is an opportunistic virus typically diagnosed in immunocompromised patients. CMV proctitis is rarely reported in immunocompetent hosts. We describe a 71-year-old immunocompetent male who presented with persistent diarrhea and was CMV-negative on initial histopathology staining but was found to have severe CMV proctitis with rectal involvement diagnosed following repeat flexible sigmoidoscopy. CMV proctitis is likely an underrecognized cause of bloody diarrhea in the elderly. Early consideration of CMV proctitis in immunocompetent elderly patients with refractory colitis may prevent prolonged morbidity and unnecessary immunosuppressive therapy.

Figures