Abstract
A 75-year-old man with adult T-cell leukemia (ATL) was admitted to the hospital because of abdominal pain. His abdomen was distended with muscular rigidity. Abdominal CT scan demonstrated the presence of free air. An emergency laparotomy was performed with a diagnosis of visceral perforation. At surgery, a perforation 5 mm in diameter was recognized at the jejunum, 100 cm distal from the ligament of Treitz. We also found multiple small soft nodules along the entire small intestine. Partial resection of the jejunum was performed. Microscopic findings disclosed a small intestinal perforation due to CMV infection. Ganciclovir was started on post-operative day 7 based on the pathological diagnosis. Eight days after the operation, wound dehiscence occured and abdominal closure was performed immediately. However the patient died from sepsis and multiple organ failure on post-operative day 9. Although gastrointestinal perforation caused by CMV infection is very rare, CMV infection should be included in the differential diagnosis in an immuno-compromised host, such as the patients with ATL.
