P1697 - Navigating the Clinical Challenges: CMV Gastroenteritis in a Cardiac Sarcoidosis Patient on Immunosuppression and Concurrent COVID-19 Infection

Chengu Niu, MD¹, Muhammad Farhan Ashraf, MD¹, Tausif Syed, MD¹, Ali Jaan, MD¹, Jing Zhang, MD², Patrick Okolo, MD^1
1Rochester General Hospital, Rochester, NY; ²Rainier Springs Hospital, Vancouver, WA

Introduction: Cytomegalovirus (CMV) gastroenteritis predominantly affects immunocompromised individuals, leading to severe complications. Given the high prevalence of CMV and the increasing number of individuals with compromised immune systems, this condition presents significant clinical challenges. This report presents a unique case of CMV gastroenteritis in a 73-year-old male with cardiac sarcoidosis, who was on immunosuppressive therapy.

Case Description/Methods: A 73-year-old male with heart failure secondary to cardiac sarcoidosis, Non-Hodgkin's lymphoma, chronic idiopathic thrombocytopenic purpura, and type 2 diabetes mellitus was admitted with dizziness, chronic diarrhea, and weight loss. Notably, the patient was on immunosuppressive therapy with mycophenolate and methotrexate, which were discontinued upon admission. Gastrointestinal endoscopy revealed Barrett's esophagus, gastric erosions, and gastric polyps, while colonoscopy showed diffuse minimal fibrinous exudate with underlying erythema. Endoscopic biopsies confirmed CMV colitis and gastritis. Concurrently, he was diagnosed with asymptomatic COVID-19 and received a five-day course of remdesivir.He was started on intravenous ganciclovir, but his condition deteriorated, leading to a cardiac arrest from which he could not be resuscitated.

Discussion: This case underscores the complexity of managing CMV gastroenteritis in patients with multiple comorbidities on immunosuppressive therapy. The timely discontinuation of immunosuppressants, swift diagnosis, and initiation of treatment for CMV gastroenteritis were pivotal in this case. Furthermore, the concurrent COVID-19 infection added another layer of complexity. Although the patient was asymptomatic for COVID-19, its potential impact on his immune status could have affected the course and management of CMV gastroenteritis.



Disclosures:


Chengu Niu, MD¹, Muhammad Farhan Ashraf, MD¹, Tausif Syed, MD¹, Ali Jaan, MD¹, Jing Zhang, MD², Patrick Okolo, MD¹. P1697 - Navigating the Clinical Challenges: CMV Gastroenteritis in a Cardiac Sarcoidosis Patient on Immunosuppression and Concurrent COVID-19 Infection, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.