Kim Kye Whon, Kim Min Cheol
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
J Int Med Res. 2025 Jan;53(1):3000605241311449. doi: 10.1177/03000605241311449.
Cytomegalovirus (CMV) infection typically affects immunocompromised individuals. However, CMV-associated enteritis involving the entire small intestine is rare in immunocompetent patients. We report a case of a 60-year-old immunocompetent woman with a history of diabetes mellitus who presented with diarrhea for 3 weeks. Abdominal computed tomography and stool tests revealed panenteritis accompanied by protein-losing enteropathy. Enteroscopy revealed ulcerative mucosa throughout the small intestine, and subsequent biopsies confirmed CMV-associated enteritis. Initial treatment with intravenous ganciclovir was complicated by pancytopenia, leading to its discontinuation and a switch to oral valganciclovir. This adjustment led to significant clinical improvement and symptom resolution. This case highlights the importance of considering CMV-associated enteritis in immunocompetent patients presenting with unexplained gastrointestinal symptoms and demonstrates the effectiveness of oral valganciclovir following ganciclovir-induced pancytopenia.
巨细胞病毒（CMV）感染通常影响免疫功能低下的个体。然而，在免疫功能正常的患者中，累及整个小肠的CMV相关性肠炎较为罕见。我们报告一例60岁免疫功能正常的女性糖尿病患者，出现腹泻3周。腹部计算机断层扫描和粪便检查显示全肠炎伴蛋白丢失性肠病。小肠镜检查发现整个小肠黏膜溃疡，随后的活检证实为CMV相关性肠炎。初始静脉注射更昔洛韦治疗出现全血细胞减少并发症，导致停药并改用口服缬更昔洛韦。这种调整带来了显著的临床改善和症状缓解。该病例强调了在出现不明原因胃肠道症状的免疫功能正常患者中考虑CMV相关性肠炎的重要性，并证明了在更昔洛韦引起全血细胞减少后口服缬更昔洛韦的有效性。
