Cytomegalovirus infection in gastrointestinal tract: A case series of three patients and review of literature

Cytomegalovirus disease can involve any site of gastrointestinal tract from oral cavity to rectum. CMV disease most frequently occurs in patients' with immune deficiency, such as the acquired immunodeficiency syndrome, after organ transplantation, after cancer chemotherapy and in patients on immunosuppressive medications. The number of patients with immune deficiency has increased in recent years and has lead to a substantial increase in incidence of opportunistic CMV virus. Gastrointestinal CMV infection has also been reported in immunocompetent adults. Symptoms and signs depend on part of the gastrointestinal tract involved. Diagnosis depends either on a positive mucosal biopsy or by serology, quantitative PCR or CMV antigenemia. We report three cases of CMV infection in patients with three different underlying conditions and discuss the clinical features, diagnostic approach and treatment. All patients had positive serology with high viral load on PCR. Histology with immunohistochemistry was positive for CMV in two of the three cases. Ganciclovir response was seen in all patients in respect to clinical improvement, endoscopic resolution of lesions and clearing of the virus load.