Fatal Case of Perforated Cytomegalovirus Colitis: Case Report and Systematic Review

Surg Infect (Larchmt). 2022 Mar;23(2):127-134. doi: 10.1089/sur.2021.173. Epub 2021 Dec 2.


Objective: We describe a patient with history of heart transplant on maintenance immunosuppression who presented with sigmoid colon perforation from cytomegalovirus (CMV) colitis and performed a systematic review of outcomes after perforated CMV colitis. Background: Cytomegalovirus enterocolitis is uncommon among solid organ transplant patients and can result in small or large bowel perforation. Methods: We systematically reviewed articles describing patients with CMV enterocolitis with small or large bowel perforations from PubMed, Embase, and Web of Science from database inception to February 2021. Results: Seventy-seven articles were identified containing 84 patients with perforated CMV enterocolitis. The most prevalent comorbid diagnosis was human immunodeficiency virus (HIV; 27 patients, 32%), and 37 patients (44%) were taking corticosteroids at time of presentation. The ileum was the most common location for a perforation (26 patients, 31%). Odds of survival were lower for patients with small bowel perforation (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.14-0.98) and HIV/acquired immunodeficiency syndrome (AIDS; OR, 0.32; 95% CI, 0.11-0.88). Odds of survival were higher for patients with large bowel perforation (OR, 2.64; 95% CI, 1.03-7.09), radiographically diagnosed perforation (OR, 3.45; 95% CI, 1.12-11.60) and those who received a CMV antiviral (OR, 9.19; 95% CI, 3.26-28.48). Conclusions: Perforated CMV enterocolitis is uncommon even in immunocompromised hosts. Clinicians should maintain a high level of suspicion for CMV-induced bowel perforation in this population because antiviral treatment is associated with increased odds of survival.

Keywords: CMV enterocolitis; ganciclovir; intestinal perforation; post-transplant immunosuppression.

Publication types

  • Case Reports
  • Systematic Review

MeSH terms

  • Antiviral Agents / therapeutic use
  • Colitis* / complications
  • Colitis* / drug therapy
  • Cytomegalovirus
  • Cytomegalovirus Infections* / complications
  • Cytomegalovirus Infections* / drug therapy
  • Enterocolitis* / complications
  • Enterocolitis* / drug therapy
  • Ganciclovir / therapeutic use
  • Humans


  • Antiviral Agents
  • Ganciclovir