A case of first-episode ulcerative colitis detected by first infection with cytomegalovirus

Abstract

A 19-year-old man visited our clinic with chief complaints of fever and diarrhea. Computed tomography revealed edematous wall thickening. Coloscopy indicated continuous circumferential edematous mucosa with irregular erosion. Although ulcerative colitis (UC) could not be ruled out, large intranuclear inclusions and anti-cytomegalovirus (CMV) antibody-positive cells were noted. Additionally, blood tests were positive for C7HRP and CMV-IgM with a high titer. Based on these findings, CMV enteritis due to the initial infection was diagnosed. Despite conservative treatment, edematous mucosa and anti-CMV antibody-positive cells persisted. Consequently, valganciclovir treatment was initiated. However, follow-up endoscopic findings showed no improvement. Given these findings, the patient was ultimately diagnosed with UC as the initial manifestation, complicated by CMV enteritis due to primary infection.