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A Series of 5 Cases : First report from India of five cases of Cytomegalovirus (CMV) related Rectal Bleeding in Covid-19 immunocompetent patients.
India
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New Delhi, June 29, 2021 :
According to Prof. Anil Arora, Chairman, Institute of Liver Gastroenterology and Pancreaticobiliary Sciences, Sir Ganga Ram Hospital, “During second wave of the COVID-19, in April-May 2021 we have seen five cases of CMV infection in otherwise immunocompetent patients with COVID-19. These patients presented with pain abdomen and bleeding in stools. These patients presented with a mean of 20 to 30 days after the diagnosis of Covid-19. None of them had other predisposing immunosuppressed states accounting for this viral infection”.
Covid infection itself and the medicines used for its treatment (steroids) do suppress the immunity of patients and make them susceptible for uncommon infections with varied presentations. One such opportunistic infection is (CMV) virus. Cytomegalo virus exists in 80 to 90 % of the Indian population in asymptomatic form as our immunity is strong enough to make it clinically asymptomatic. Clinical presentation with symptoms secondary to CMV is usually seen in patients whose immunity is compromised.
But in our series all patients presented with low lymphocyte count (6-10% as against a normal of 20 to 40%) indicating covid induced suppression of immunity predisposing them to symptomatic reactivation of CMV infection.
Out of five cases with age group of 30-70 years were from Delhi NCR, four had presented with lower gastrointestinal bleed that is bleeding in stools and one patient presented with intestinal obstruction. Two of them had massive bleed, one requiring emergency lifesaving surgery in the form of removal of right side of the colon and one of them has succumbed due to massive bleeding and severe Covid chest disease.
Other three patients were successfully treated with antiviral therapy with Ganciclovir says Prof. Anil Arora. Cytomegalovirus colitis was confirmed by PCR testing for CMV viremia and tissue biopsy from the large intestine which showed intranuclear inclusion bodies which was further confirmed to be due to CMV infection by the specific immunohistochemistry stains says Dr. Sunila Jain, Senior Consultant Pathologist, Sir Ganga Ram Hospital.
In such cases a high index of suspicion and timely intervention in the form of an early diagnosis and effective antiviral therapy can save many a precious lives says Dr. Praveen Sharma, Senior Consultant, Gastroenterology Department, Sir Ganga Ram Hospital.
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