A 28-year-old immunocompetent male developed self-limited postprandial abdominal pain, diarrhea, and a 10-pound weight loss alongside positive cytomegalovirus serology, presenting diagnostic challenges regarding tissue-invasive disease, Cureus reported.
The case, detailed in recent medical literature, highlights the complexities of attributing acute gastrointestinal symptoms to cytomegalovirus (CMV) without obtaining acute-phase viral polymerase chain reaction (PCR) or histopathologic tissue confirmation. While CMV affects roughly 60% of adults in developed nations and over 90% in developing countries, end-organ gastrointestinal disease remains uncommon in patients with intact immune systems.
Physicians typically observe CMV colitis in older adults or immunocompromised individuals with underlying risk factors such as chronic steroid exposure, inflammatory bowel disease, or advanced age. In this patient, however, the clinical presentation included class II obesity, elevated transaminases, and mild splenomegaly, raising early suspicion for a systemic viral illness.
Initial laboratory evaluations at the family medicine clinic revealed a white blood cell count of 9.4 K/µL with an absolute lymphocyte count of 4.8 K/µL, alongside aspartate aminotransferase at 121 IU/L and alanine aminotransferase at 122 IU/L. An abdominal computed tomography scan with contrast subsequently documented mild splenomegaly and nonspecific submucosal fat deposition in the colon.
Follow-up serologies confirmed positive anti-CMV immunoglobulin M and immunoglobulin G antibodies. Concurrently, Epstein-Barr virus (EBV) viral capsid antigen IgM and IgG as well as nuclear antigen IgG returned positive, though an EBV quantitative blood PCR was negative. Human immunodeficiency virus antigen and antibody testing remained nonreactive.
Because clinicians did not perform CMV quantitative PCR or colonic mucosal biopsies during the acute phase of the illness, establishing a definitive causal link between the virus and the gastrointestinal symptoms proved unfeasible. The patient’s symptoms gradually improved without antiviral intervention, such as ganciclovir, which is typically reserved for severe or confirmed tissue-invasive manifestations.
Two months after the initial clinic visit and following the complete clinical resolution of his gastrointestinal symptoms, the patient underwent a repeat abdominal computed tomography scan and a subsequent colonoscopy. Biopsies harvested from the cecum, splenic flexure, and rectum revealed benign colonic mucosa with lymphoid aggregates.
The official pathology report identified no microscopic evidence of active or residual cytomegalovirus infection. Medical experts note that delayed tissue sampling following spontaneous recovery can yield negative results due to the resolution of an earlier inflammatory process or the sampling of previously uninvolved mucosal areas.
| Clinical Parameter | Initial Presentation Value | Reference Range |
|---|---|---|
| White Blood Cell Count | 9.4 K/µL | 4.4 – 10.1 K/µL |
| Absolute Lymphocyte Count | 4.8 K/µL | 1.4 – 2.9 K/µL |
| Aspartate Aminotransferase | 121 IU/L | <34 IU/L |
Consequently, healthcare providers emphasize that positive serology alone does not confirm tissue-invasive gastrointestinal disease. Alternative self-limited enteric infections or concurrent systemic viral processes could have driven the clinical presentation observed in this young adult.
Endoscopic procedures like colonoscopy also require careful risk stratification when patients have severe acute colonic inflammation, as premature instrumentation may elevate the risk of bowel perforation. Professional guidance remains essential to rule out alternative bacterial or viral pathogens before attributing gastrointestinal distress to herpesvirus infections.
- Cureus: Self-Limited Gastrointestinal Illness With Positive Cytomegalovirus Serology in a Young Immunocompetent Adult: A Case Report.
- Centers for Disease Control and Prevention (CDC): Cytomegalovirus (CMV) and Congenital CMV Infection Information.
- World Health Organization (WHO): Guidelines on Clinical Management of Acute Enteric Infections.
