Immunosuppression from human immunodeficiency virus (HIV) or other comorbidities increases susceptibility to gastrointestinal infections such as Entamoeba histolytica and cytomegalovirus (CMV). Although each pathogen can independently cause severe colitis, co-infection is rare and may lead to rapid clinical deterioration if not recognized early. We report two cases of concurrent amebic and CMV colitis in immunocompromised patients. The first patient, a 56-year-old man with HIV, Kaposi sarcoma, and hepatitis C, presented with bloody diarrhea and hypotension. Colonoscopy revealed pancolitis with ulcerations, and biopsy initially confirmed E. histolytica . Despite an initial response to anti-amebic therapy, he later developed recurrent bleeding and sepsis and died on hospital day 24. Postmortem pathological examination subsequently identified CMV co-infection. The second patient, a 48-year-old HIV-negative man with diabetes, chronic hepatitis B and C, and prior colorectal cancer, presented with 1 month of bloody diarrhea. Colonoscopy and histopathology confirmed dual infection, which was successfully treated with metronidazole and ganciclovir. A follow-up colonoscopy later demonstrated complete resolution. These cases highlight the importance of early endoscopic evaluation and tissue diagnosis in immunocompromised patients with persistent bloody diarrhea, as prompt recognition of co-infection allows timely, targeted therapy and may prevent fatal outcomes.
Lin et al. (Wed,) studied this question.