Hae Seong Kim, DO, Angela Baquiran, MD, Narayan Dharel, MD Mary Washington Healthcare, Fredericksburg, VA Introduction: Cytomegalovirus (CMV) colitis is an opportunistic infection predominantly affecting immunocompromised individuals. The clinical presentation of CMV colitis is often nonspecific, including symptoms such as diarrhea, abdominal pain, and fever. Although gastrointestinal bleeding is a recognized complication of CMV colitis, the development of severe acute anemia from substantial hemorrhage remains a rare but serious clinical scenario.
Case Description/
Methods: We report a case of a 52-year-old male with a medical history of human immunodeficiency virus (HIV) who presented to the emergency department with complaints of ongoing rectal bleeding for 3–4 weeks, associated with progressive dizziness and shortness of breath. Initial evaluation revealed significant anemia. The patient underwent esophagogastroduodenoscopy (EGD) and colonoscopy to investigate the source of bleeding. EGD was unremarkable; however, colonoscopy revealed a diffusely congested, erythematous, eroded, hemorrhagic, and inflamed mucosa throughout the colon. Biopsy of the sigmoid colon demonstrated histopathological features consistent with CMV colitis. Discussion: This case highlights the importance of considering CMV colitis in the differential diagnosis of gastrointestinal bleeding and anemia in immunocompromised patients, especially those with HIV. Early recognition and diagnosis are critical for timely initiation of antiviral therapy and improved patient outcomes.
Figure: Sigmoid colon with diffuse areas of moderately congested, erythematous, eroded, hemorrhagic, and inflamed mucosa
Figure: Histology showing CMV infection.
Disclosures: Hae Seong Kim indicated no relevant financial relationships. Angela Baquiran indicated no relevant financial relationships. Narayan Dharel indicated no relevant financial relationships.
Hae Seong Kim, DO, Angela Baquiran, MD, Narayan Dharel, MD. P3491 - Acute Lower Gastrointestinal Hemorrhage From Cytomegalovirus Colitis Leading to Severe Anemia, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
