Abstract
Objective:
We describe a patient with history of heart transplant on maintenance immunosuppression who presented with sigmoid colon perforation from cytomegalovirus (CMV) colitis and performed a systematic review of outcomes after perforated CMV colitis.
Background:
Cytomegalovirus enterocolitis is uncommon among solid organ transplant patients and can result in small or large bowel perforation.
Methods:
We systematically reviewed articles describing patients with CMV enterocolitis with small or large bowel perforations from PubMed, Embase, and Web of Science from database inception to February 2021.
Results:
Seventy-seven articles were identified containing 84 patients with perforated CMV enterocolitis. The most prevalent comorbid diagnosis was human immunodeficiency virus (HIV; 27 patients, 32%), and 37 patients (44%) were taking corticosteroids at time of presentation. The ileum was the most common location for a perforation (26 patients, 31%). Odds of survival were lower for patients with small bowel perforation (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.14–0.98) and HIV/acquired immunodeficiency syndrome (AIDS; OR, 0.32; 95% CI, 0.11–0.88). Odds of survival were higher for patients with large bowel perforation (OR, 2.64; 95% CI, 1.03–7.09), radiographically diagnosed perforation (OR, 3.45; 95% CI, 1.12–11.60) and those who received a CMV antiviral (OR, 9.19; 95% CI, 3.26–28.48).
Conclusions:
Perforated CMV enterocolitis is uncommon even in immunocompromised hosts. Clinicians should maintain a high level of suspicion for CMV-induced bowel perforation in this population because antiviral treatment is associated with increased odds of survival.
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