P0157 - A Case of Cytomegalovirus Proctocolitis in an Immunocompetent Patient

Shuhaib S. Ali, DO, Farah Ladak, MD, Landon Brown, MD, Alexis Maximos, MD
University of Texas Health Science Center at San Antonio, San Antonio, TX

Introduction: Cytomegalovirus (CMV) disease is a viral infection known to cause opportunistic infections in many organ systems, mononucleosis-like syndromes, or even a post-transplant lymphoproliferative disorder in immunocompromised patients; however, infection is usually self-limited in immunocompetent individuals. CMV infection is rarely seen amongst young immunocompetent patients, with the colon being the most commonly affected organ. Primary CMV proctocolitis can present with fevers, rectal bleeding, and dyschezia within several days to two weeks after unprotected anal intercourse in young patients. We describe a case of a young immunocompetent patient with primary CMV proctocolitis after anal penetration.

Case Description/Methods: A thirty-year-old male with no significant past medical history presented with fever, hematochezia, and dyschezia that began shortly after unprotected anal receptive intercourse with his partner. The patient denied any foreign object insertion. Due to persistent symptoms and a subjective fever, patient sought further medical care and was admitted to the hospital for further evaluation. On arrival, vital signs were pertinent for tachycardia to 103 bpm. The patient’s work up included a computed tomography imaging that was concerning for proctocolitis. A sexually transmitted infection screen, which included gonorrhea, chlamydia, and syphilis serologies were negative. Alanine and Aspartate Aminotransferases (AST and ALT) were elevated at 50 and 48 U/L, respectively. The patient underwent a flexible sigmoidoscopy which showed beefy, raised, erythematous lesions extending to 20 cm from the anal verge. A large coalescing clean-based ulcer was also observed in the distal rectum. Biopsies obtained showed findings indicative of CMV. CMV DNA PCR was elevated to 5,990 IU/mL. HIV serologies, including HIV RNA, were negative. The patient was initially treated with ganciclovir and then transitioned to valganciclovir. The patient’s symptoms improved with treatment and was discharged with follow-up with Gastroenterology and Infectious Disease. After completion of anti-viral therapy, his CMV DNA PCR, AST, and ALT normalized.

Discussion: This is a unique and rare case of an immunocompetent patient who developed CMV proctocolitis occurring in the setting of mucosal disruption from anal intercourse resulting in sexual transmission of CMV. This case demonstrates the importance of considering CMV as a rare cause of proctocolitis in an immunocompetent patient.


Disclosures:
Shuhaib Ali indicated no relevant financial relationships.
Farah Ladak indicated no relevant financial relationships.
Landon Brown indicated no relevant financial relationships.
Alexis Maximos indicated no relevant financial relationships.


Shuhaib S. Ali, DO, Farah Ladak, MD, Landon Brown, MD, Alexis Maximos, MD. P0157 - A Case of Cytomegalovirus Proctocolitis in an Immunocompetent Patient, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.