Abstract
The patient was a 68-year-old woman who had been diagnosed with malignant lymphoma eight years earlier and was in a remission state with long-term oral prednisolone regimen for recurrence after chemotherapy and peripheral stem cell transplantation. Recently she was seen at the hospital because of a two-week history of poor appetite. An abdominal CT scan demonstrated extra-intestinal free air in the vicinity of the rectum in the minor pelvis. Emergency operation was performed with a diagnosis of rectal perforation. Pathological study disclosed that the perforation was caused by cytomegalovirus (CMV) enteritis. Because the patient had already been given ganciclovir, the dose of the drug was increased but the patient still exhibited positive CMV antigenemia. Symptoms recurred about two months later, when we selected conservative therapy because her general condition was poor and were able to avoid surgical intervention. Thereafter oral ganciclovir regimen has been maintained to preserve further recurrence and the patient is now on home nursing.
In the treatment of intestinal perforation in the immunosuppressive patient, we actively suspect the presence of cytomegalovirus enteritis and early administration of antiviral agent is desirable.
