Acute Hemorrhagic Rectal Ulcer Complicated by Cytomegalovirus Enteritis following Steroid Pulse Therapy for Acute Exacerbation of Interstitial Pneumonia

Intern Med. 2023 Aug 15;62(16):2335-2339. doi: 10.2169/internalmedicine.0823-22. Epub 2022 Dec 21.

Abstract

We herein report a rare case of acute hemorrhagic rectal ulcer (AHRU) complicated by cytomegalovirus enteritis following steroid pulse therapy for interstitial pneumonia. An 86-year-old woman underwent steroid pulse therapy for interstitial pneumonia. She was bedridden with dyspnea and suddenly developed melena. Colonoscopy revealed AHRU, which did not improve with conservative treatment, but did improve with ganciclovir administration for cytomegalovirus enteritis. This gastrointestinal complication has not received much attention by pulmonologists who perform steroid pulse therapy for interstitial pneumonia. Delayed treatment of this complications can be fatal. Caution should be taken when administering steroid pulse therapy to bedridden patients with interstitial pneumonia.

Keywords: acute hemorrhagic rectal ulcer; bedridden status; cytomegalovirus enteritis; interstitial pneumonia; steroid pulse therapy.

Publication types

  • Case Reports

MeSH terms

  • Acute Disease
  • Aged, 80 and over
  • Colonic Diseases* / complications
  • Cytomegalovirus
  • Cytomegalovirus Infections* / complications
  • Cytomegalovirus Infections* / drug therapy
  • Enteritis* / complications
  • Enteritis* / drug therapy
  • Female
  • Gastrointestinal Hemorrhage / complications
  • Gastrointestinal Hemorrhage / etiology
  • Humans
  • Lung Diseases, Interstitial* / complications
  • Lung Diseases, Interstitial* / drug therapy
  • Steroids
  • Ulcer / complications
  • Ulcer / drug therapy

Substances

  • Steroids