Nakashima Kei, Aoshima Masahiro, Suzuki Fumi, Watanabe Junko, Otsuka Yoshihito
Department of Pulmonary Medicine, Kameda Medical Center, Japan.
Intern Med. 2016;55(5):527-31. doi: 10.2169/internalmedicine.55.4857. Epub 2016 Mar 1.
A 68-year-old man visited an emergency department complaining of dyspnea. He was diagnosed to have Legionella pneumonia with multiple organ failure. Although his multiple organ failure improved, he suffered from persistent abdominal pain and diarrhea with continuous minor bleeding. Colonoscopy revealed a longitudinal ulcer of the rectum, below the peritoneal reflection. He was diagnosed with cytomegalovirus (CMV) colitis. Antiviral therapy with ganciclovir was initiated. He finally underwent a colostomy after a bowel stricture caused an intestinal outlet obstruction, which made oral intake impossible. Based on the present case, we believe that CMV colitis must be considered as one of the differential diagnoses when critically ill patients develop continuous diarrhea and abdominal pain.
一名68岁男性因呼吸困难前往急诊科就诊。他被诊断为军团菌肺炎伴多器官功能衰竭。尽管他的多器官功能衰竭有所改善，但仍持续存在腹痛、腹泻并伴有持续少量出血。结肠镜检查发现直肠有一个位于腹膜反折下方的纵行溃疡。他被诊断为巨细胞病毒（CMV）结肠炎。开始使用更昔洛韦进行抗病毒治疗。由于肠道狭窄导致肠梗阻，无法经口进食，他最终接受了结肠造口术。基于本病例，我们认为当重症患者出现持续腹泻和腹痛时，CMV结肠炎必须被视为鉴别诊断之一。
