Gold induced enterocolitis complicated by cytomegalovirus infection: a previously unrecognised association.

Enterocolitis is a rare complication of treatment with gold salts. It was first described in 1935 by Goldhammer2 and since then only 21 cases have been described.>"7118 The mechanism is unclear. An appreciable proportion of these cases was associated with high morbidity and mortality.4 781' Different treatment regimes including intensive supportive care with a combination of antibiotics, steroids, dimercaprol, and disodium cromoglycate have produced variable success.5 713 '5 No other concomitant infective agents have been implicated in the course of the disease to date. We report a case of gold induced enterocolitis complicated by cytomegalovirus (CMV) infection that responded to treatment with intravenous gangcyclovir. namely, oral 20 mg prednisolone daily in a reducing dose and ampicillin. There was a reduction in her stool frequency, an improvement in her abdominal pain, and a less productive cough. She was discharged after one week but four weeks later, she relapsed with symptoms of watery diarrhoea and fresh blood, abdominal pain, and a further weight loss of 6 3 kg. Also, her productive cough had persisted. Her only medication was dihydrocodeine. On examination she was moribund and dehydrated. She was apyrexial and a maculopapular rash was present on her arms. Chest examination showed left basal crepitations and her abdomen was diffusely tender but bowel sounds were present. Moderate peripheral leg oedema was also noted.