Abstract
A 68-year-old male was referred to our hospital because of fever and diarrhea. Blood examination revealed an elevated C-reactive protein (CRP) level and normal white blood cell (WBC) count. Abdominal computed tomography (CT) revealed rectal wall thickening and densification of the surrounding fatty tissue. On admission, we treated the patient under the provisional diagnosis of common infectious colitis caused by food poisoning, but his symptoms did not respond. On colonoscopy, a circular ulcer in the upper rectum with granular mucosa was observed. This lesion assumed an appearance similar to spawn (mass of fish eggs). Pathological diagnosis of colonic mucosal biopsy samples with the cytomegalovirus antigenemia assay demonstrated cytomegalovirus (CMV) infection. The patient was then treated with valganciclovir and his symptoms quickly improved. The result from our patient suggests that we should perform colonoscopy and cytomegalovirus antigenemia assay in patients with refractory colitis. In addition, there is no reported case of cytomegalovirus colitis with ‘spawn-like’ ulcer until now.
