eMedicine Specialties > Gastroenterology > Colon

Cytomegalovirus Colitis: Differential Diagnoses & Workup

Author: Deron J Tessier, MD, Staff Surgeon, Kaiser Permanente Medical Center, Fontana, CA
Coauthor(s): Russell A Williams, MBBS, Program Director, Professor, Department of Surgery, University of California Medical Center at Irvine
Contributor Information and Disclosures

Updated: Oct 10, 2006

Differential Diagnoses

Campylobacter Infections
Gastroenteritis, Viral
Clostridium Difficile Colitis
Megacolon, Toxic
Colon Cancer, Adenocarcinoma
Mycobacterium Avium-Intracellulare
Crohn Disease
Ulcerative Colitis
Cryptosporidiosis
Gastroenteritis, Bacterial

Other Problems to Be Considered

Acquired immunodeficiency syndrome
Entamoeba histolytica infection
Ischemic colitis

Workup

Laboratory Studies

  • Antigen detection: Direct specific immunofluorescent antibody detects viral antigens or viral DNA.
  • Culture techniques: The shell viral assay using monoclonal antibodies can detect immediate early antigens. Shell viral assay cultures reduce the time to positivity to 24-72 hours, whereas other cultures take days to weeks.
  • Other diagnostic studies: Tests such as antibody tests, qualitative or quantitative polymerase chain reaction, or studies of serum or other body fluids yield less diagnostic information.
  • Other co-infecting pathogens must be excluded by appropriate smears, cultures, and serologic studies.
  • A rising alkaline phosphatase level was the initial laboratory abnormality seen in one patient with CMV colitis.

Imaging Studies

  • Imaging studies may demonstrate bowel wall thickening, mucosal ulcerations (see Media file 1), and luminal narrowing.

Procedures

  • The study of choice is sigmoidoscopy or colonoscopy, which allows direct visualization and the opportunity to obtain biopsy specimens that may aid in diagnosis.
    • Endoscopy may demonstrate mucosal erythema, erosions, ulcerations, hemorrhage, or nodular-plaque or polypoid lesions.
    • Specimens should be submitted for histologic examination, antigen detection, and viral cultures.
    • Lesions may mimic neoplastic processes.

Histologic Findings

Affected specimens may show acute and chronic inflammatory changes, vasculitis, and/or mucosal ulceration. Deep biopsy specimens are preferred. Staining with Papanicolaou or hematoxylin and eosin stains may reveal classic findings, which include giant cells (usually 25-35 µm, see Media file 2) with cytomegaly and large ovoid or pleomorphic nuclei containing basophilic inclusions (owl's eyes, halo rim). Recent data suggest that immunohistochemical staining may be more sensitive for detecting CMV.

More on Cytomegalovirus Colitis

Overview: Cytomegalovirus Colitis
Differential Diagnoses & Workup: Cytomegalovirus Colitis
Treatment & Medication: Cytomegalovirus Colitis
Follow-up: Cytomegalovirus Colitis
Multimedia: Cytomegalovirus Colitis
References
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References

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  3. Dieterich DT, Kotler DP, Busch DF, et al. Ganciclovir treatment of cytomegalovirus colitis in AIDS: a randomized, double-blind, placebo-controlled multicenter study. J Infect Dis. - Busch DF;167(2):278-82. [Medline].

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Further Reading

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Keywords

CMV, CMV infection, Herpesviridae, herpesvirus, herpes simplex virus, HSV, Epstein-Barr virus, varicella-zoster virus, HIV, AIDS, CMV colitis, CMV gastrointestinal disease, CMV GI disease, HIV disease complications, bloody diarrhea, watery diarrhea, AIDS complications, CMV ulcerative colitis, cytomegalovirus ulcerative colitis, cytomegalovirus UC, steroid-dependent ulcerative colitis, cytomegalovirus infection, cytomegalovirus

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Contributor Information and Disclosures

Author

Deron J Tessier, MD, Staff Surgeon, Kaiser Permanente Medical Center, Fontana, CA
Deron J Tessier, MD is a member of the following medical societies: American College of Surgeons and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Russell A Williams, MBBS, Program Director, Professor, Department of Surgery, University of California Medical Center at Irvine
Russell A Williams, MBBS is a member of the following medical societies: American College of Surgeons, American Pancreatic Association, Association for Surgical Education, Association of VA Surgeons, Society for Surgery of the Alimentary Tract, Southern California Society of Gastroenterology, and Southwestern Surgical Congress
Disclosure: Nothing to disclose.

Medical Editor

Jeffrey D Band, MD, Clinical Professor of Medicine, Wayne State University School of Medicine; Director, Division of Infectious Diseases and International Medicine, William Beaumont Hospital Corporation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

James L Achord, MD, Professor Emeritus, Department of Medicine, Division of Digestive Diseases, University of Mississippi School of Medicine
James L Achord, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, Mississippi State Medical Association, New York Academy of Sciences, Sigma Xi, and Southern Medical Association
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

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