Abstract
We report a case of perforative peritonitis due to cytomegalovirus (CMV) colitis in a patient with refractory idiopathic thrombocytopenic purpura (ITP). A 55–year–old woman with thrombocytopenia caused by refractory ITP was treated with steroids despite having undergone total splenectomy for ITP treatment. She was admitted to our hospital with pyrexia and vomiting, and thereafter developed severe diarrhea. CMV enterocolitis was diagnosed based on the presence of serum antigenemia, and ganciclovir therapy was initiated. However, the patient developed panperitonitis during the therapy. An emergency laparotomy revealed perforations in the transverse and descending colon. The affected left colon was resected, and primary anastomosis was performed. Histopathological examination of the surgical specimen resulted in a final diagnosis of perforations due to CMV colitis. The patient had a favorable postoperative course. It should be considered that CMV enterocolitis is one of the most severe complications affecting patients undergoing steroid treatment. Especially, intestinal perforation due to CMV enterocolitis may result in a poor prognosis, and therefore, early diagnosis and surgical therapy in these patients are of utmost importance.
