Colonoscopic Features of Cytomegalovirus Colitis and Clinical Experience

Cytomegalovirus (CMV) colitis is the most common infection of the CMV gastrointestinal disease. Patients with CMV colitis soften manifest with fever, abdominal pain, watery diarrhea, bloody stool, massive bleeding and occasionally with mega colon and perforation. Colonic ulcer bleeding can be self-limited, but may recur intermittently. Massive colonic bleeding and perforation can be life-threatening. CMV colitis could be concurrently with or following the treatment for Clostridium difficile infection-associated colitis of the patients. Diagnosis of CMV colitis relies on colonoscopy with biopsies. Endoscopic features are quite variable and include diffuse erythema, hemorrhagic spots, ischemia, erosions, ulcers, strictures, polypoids, pseudo membranes and pseudo tumors. Specific colonoscopic findings of CMV ulcers are irregular ulceration, map-like appearance, wide mucosal defect, punched-out ulceration and longitudinal ulceration. Histological mucosal specimens typically show viral inclusions, referred to as owl’s eyes. The immune histochemical staining to detect of CMV antigen is a more sensitive method. The CMV quantitative polymerase chain reaction or the CMV antigenemia assay can be used as an accurate method to predict CMV disease and to monitor effectiveness of treatment. However,