[Cytomegalovirus colitis simulating neoplasm in a patient with HIV infection].

AIM

Cytomegalovirus colitis occurs in at least 5-10% of patients with AIDS. The most usual form of clinical presentation is that of a chronic picture of diarrhea, fever and abdominal pain in a patient with AIDS with a CD4 lymphocyte count lower than 100/mm3, although it can be the diagnostic index for AIDS up to in 25% of the cases.

METHODS

Cytomegalovirus colitis in a patient with AIDS was diagnosed by endoscopy and colonic biopsy. The clinical was diagnosed by endoscopy and colonic biopsy. The clinical picture consisted of abdominal pain, without the findings of fever and diarrhea described in almost 80% and 100% respectively of the cases published in the literature. The barium enema carried out showed a stenotic appearance, like serviette ring, in the ascending colon, which suggested neoplasia of the colon.

RESULTS

Induction therapy with ganciclovir was effective. However, the patient was readmitted one year later for chorioretinitis due to cytomegalovirus, without any evidence of gastro-intestinal involvement.

CONCLUSIONS

Although unusual, cytomegalovirus colitis can be present with an abdominal clinical picture without diarrhea. Radiological and/or endoscopic pseudotumoral forms which this entity can adopt are often described. Endoscopy with digestive biopsy in essential for diagnosis. Therapy with ganciclovir can be effective although the reappearance of findings from cytomegalovirus can occur at another area, or as a gastrointestinal recurrence.