P1628 - You Can't Always Trust Your Gut: CMV Colitis in an Immunocompetent Patient With COVID-19

Khandokar A. Talib, MD, Khaleeq Siddiqui, MD, Yasir Ahmed, MD, Mohammad Abidi, MD, Ibrar Atiq, MD
United Health Services Hospital, Johnson City, NY

Introduction: Cytomegalovirus (CMV) is a known cause of colitis in the immunocompromised, and patients with inflammatory bowel disease (IBD), but infrequently causes colitis in immunocompetent patients. The first case of CMV colitis in an immunocompetent individual was reported in 1992. Commonly linked underlying conditions associated with CMV colitis in immunocompetent patients include renal insufficiency on hemodialysis, neurological disorders, rheumatic disease, or those exposed to antibiotics. We are presenting the first CMV colitis case possibly related to COVID-19 identified in the local area.

Case Description/Methods: A 79 -year-old female with coronary artery disease, heart failure with reduced ejection fraction, hypertension, diabetes mellitus type II, and recent COVID-19 infection was evaluated in the emergency room for nausea, vomiting, and abdominal pain. Vitals were stable and physical examination was unremarkable. Initial laboratory workup showed leukocytosis. CT scan of abdomen and pelvis with contrast suggested pancolitis with dilated loops of bowels as well as stranding inflammation around the splenic flexure. The patient was treated for ischemic and/or infectious colitis with IV Piperacillin-Tazobactam. She developed left lower lobe pneumonia and antibiotics were switched to IV Ceftriaxone and Doxycycline. The patient continued to have symptoms and reported diarrhea and low-grade fever. Repeat CT abdomen and pelvis showed diffuse thickening and dilatation throughout the colon. Fecal leukocytes were positive. Workup for Clostridium difficile, Giardia lamblia, enteric bacterial panel, and ova and parasites were negative. Colonoscopy showed severe inflammation in the descending colon, congested mucosa in the transverse and ascending colon; normal terminal ileum. Biopsies were taken from descending colon and were reported to be consistent with CMV colitis. Immunohistochemistry from biopsy specimens was also positive for CMV. A real-time PCR CMV DNA quantification test was detected. HIV test was negative. The patient was initially treated with IV Valganciclovir and later transitioned to oral Ganciclovir with complete resolution of symptoms prior to discharge. The patient was advised to follow up outpatient at Gastroenterology and Infectious disease clinic.


Discussion: While there are several known risk factors associated with CMV colitis amongst immunocompetent patients, a possible connection between COVID-19 with CMV colitis should be investigated.



Disclosures:


Khandokar A. Talib, MD, Khaleeq Siddiqui, MD, Yasir Ahmed, MD, Mohammad Abidi, MD, Ibrar Atiq, MD. P1628 - You Can't Always Trust Your Gut: CMV Colitis in an Immunocompetent Patient With COVID-19, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.