A Unique Presentation of CMV Colitis in Acute GI Bleed

Introduction: CMV colitis is a relatively common end-organ infectious complication in immunocompromised hosts which negatively affects clinical outcomes. Presentation typically includes abdominal pain and bloody diarrhea. Diagnosis methods include tissue biopsy, culture testing, and PCR. Immunohistochemistry is the most reliable method and can identify "owl eye appearance" inclusion bodies. Endoscopic exams may reveal ulcerations, mucous edema, and inflamed mucosa. Patients over 55 with underlying conditions have a higher mortality risk and early treatment can lead to decreased morbidity and mortality in CMV colitis. Case Description/Methods: We present a 75-year-old M PMH of colon polyps, liver cirrhosis, prostate cancer, ESRD on HD and recurrent GI bleed secondary to AVMs who presented with hematochezia. Laboratory results were significant for acute blood loss anemia with a hemoglobin of 6.3g/dL and thrombocytopenia 88k/ml. Colonoscopy revealed ulcerated mucosa at the IC valve, which was biopsied and treated with bipolar cautery. Notably our patient had a prior APC at that site a year ago for an AVM. Pathology revealed acute ulcerative ileocecal valve mucosa associated with CMV infection on immunostaining. The patient was discharged on valganciclovir (Figure 1). Discussion: CMV infection is an uncommon cause of GI blood loss. Furthermore, immunocompromised individuals may have variant disease presentations and susceptibility to infections like CMV. Recognizing the range of CMV presentations can aid in early diagnosis and treatment, improving patient outcomes. This case highlights the importance of considering uncommon sources of GI bleeding and consideration of biopsies even in actively bleeding ulcer bases.Figure 1.: Acute ulcerative ileocecal valve mucosa associated with CMV infection on immunostaining.