Bleeding Ulcer in a Patient with CMV Infection 2 – Example
Author: Prof. em. Dr. med. S. Liebe, University Hospital Rostock, Rostock, Germany
From: Falk Media Service D34, Endoscopy Practice on Video - Selected Diseases of the Colon
2. Edition 2012. © Falk Foundation e.V. All rights reserved.
In a 34-year-old white female patient, hemophagocytizing lymphohistiocytosis was identified as the cause of bone marrow insufficiency and immunosuppression. Diarrhea and iron deficiency anemia were present prior to the first colonoscopy. The indication for colonoscopy was the search for a source of the bleeding (Videoclip 1).
Four weeks later, life-threatening gastrointestinal bleeding set in. Gastroscopy was first performed with no evidence of a source of the bleeding; thereafter, the patient underwent a second colonoscopy (Videoclip 2).
Videoclip 2 shows changes after about four weeks. The bowel is filled with fresh blood. Following therapy, pseudomembranes are no longer seen. Finding the source of the bleeding is difficult. It is finally identified in the cecum. The bleeding is from an ulcer in a fold. The bleeding has been successfully controlled with a clip. Thereafter, the intestinal contents could be almost completely aspirated. There is no fresh bleeding in the terminal ileum.
The patient’s severe underlying disease and immunosuppression was responsible for both the serologically confirmed infection with cytomegalovirus (CMV) and also for the pseudomembranous colitis. The pseudomembranous colitis was successfully treated following the first colonoscopy. CMV colitis is associated with ulcerations, especially in the ascending colon, which are liable to bleed. (see also Videoclip 1).