2025 Volume 45 Issue 7 Pages 614-618
Cytomegalovirus (CMV) typically infects individuals in early childhood, with 60％-80％ of adults harboring antibodies. While most infections remain asymptomatic, CMV reactivation can occur in immunosuppressed individuals. CMV enteritis can affect the entire gastrointestinal tract; however, small intestinal perforation due to CMV enteritis is rare. We report such a case. A 56-year-old man with a history of schizophrenia and bronchial asthma had been receiving prednisolone for four years. In October 23, he was admitted to our emergency department with paraplegia and abdominal pain. We suspected eosinophilic granulomatosis with polyangiitis based on the patient’s symptoms and laboratory findings and initiated the patient on steroid pulse therapy with methylprednisolone (1 g/day) on November 6. On November 10, the abdominal pain recurred, and abdominal radiography and computed tomography revealed small intestinal perforation, necessitating partial bowel resection. Postoperative histopathology confirmed CMV enteritis as the cause of the perforation. Ganciclovir therapy was initiated, and serology for CMV antigen became negative by day 14. This case highlights the importance of considering CMV infection in the differential diagnosis of acute abdominal conditions in immunosuppressed patients.
