Small bowel perforation due to cytomegalovirus infection in a patient with HIV

Abstract

Cytomegalovirus can cause disseminated or localized disease in people living with HIV with advanced immunosuppression, usually those with CD4+ T-lymphocyte cell counts <50 cells/mm3 who do not receive, complies, or does not respond to antiretroviral therapy. We report on the case of a patient living with HIV without antiretroviral therapy who was admitted to the emergency department for abdominal pain. During laparotomy, perforation of the ileum was found, requiring right hemicolectomy, ileotransverse anastomosis, and drainage due to fecaloid peritonitis. The report of histopathology documented multiple cytomegalic inclusions in stromal, epithelial, and endothelial cells, predominantly in the ileum, at the level of the perforation area. Although cytomegalovirus disease in the gastrointestinal tract is one of the most common complications of HIV, ileal perforation is an unusual manifestation with high mortality.