A Case of Perforation Caused by Cytomegalovirus Enteritis during Chemotherapy for Malignant Lymphoma

Abstract

A case of jejunal perforation caused by cytomegalovirus(CMV) enteritis is presented. A 67-year-old man started chemotherapy against T cell lymphoma 2 months earlier. He had some digestive symptoms, and they got worse, with appetite loss and abdominal bloating. Upper gastrointestinal endoscopy could not detect any abnormalities. He deteriorated further and finally developed peritonitis, and he was referred for digestive surgery. Emergency surgery was performed. Operative findings showed jejunal perforation and panperitonitis. Jejunal resection and anastomosis were performed. The resected jejunum showed annular ulcers and penetration to the mesentery. Immunohistochemical staining showed CMV antigen-positive cells in an ulcer lesion. The patient was also positive for CMV antigenemia. He was therefore diagnosed with perforation of CMV enteritis. He was treated with antiviral drugs and recovered. Perforation of CMV enteritis is reported in patients with various backgrounds. However, its diagnosis is usually difficult and demands active focused examinations. We should keep CMV enteritis in mind when patients present with non-traumatic small bowel perforations.