Cytomegalovirus Enteritis Causing Ileal Perforation in an Elderly Immunocompetent Individual

Cytomegalovirus (CMV) infection can cause organ-specific damage or severe complications such as bowel perforation in immunocompromised patients. On the other hand, CMV infection in an immunocompetent individual is very rare, and only anecdotal reports have described CMV-associated bowel perforation in these patients. In the present report, we describe a healthy human immunodeficiency virus (HIV)-negative elderly man with CMV enteritis resulting in ileal perforation, and have reviewed the relevant English literature with specific reference to different ages at diagnosis. An 88-year-old healthy man was admitted with six days history of diarrhea with diffuse abdominal pain. He had no noteworthy past history or any conditions of immunosuppression, including diabetes. He denied any weight loss or fever at admission. His physical examination revealed mild distension and tenderness in the right lower abdomen without rebound tenderness. Laboratory investigation showed leukocytosis of 14.310 6 /L (normal range, 4.0-10.0) and elevated Creactive protein of 26 mg/dL (normal range, 0.0-5.0). Electrolyte disturbances and azotemia were attributed to dehydration and were easily corrected after rehydration. Blood and stool cultures were negative, and Clostridium difficile toxin was not detected. Widal test and HIV serology were also negative. Colonoscopy revealed no specific lesions from the rectum to the cecum, but intubation into the