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The HKU E-learning Platform in Clinical Medicine
The HKU E-learning Platform in Clinical Medicine
  • Physical Examination Skills
    • General Examination
    • Examination of the Cardiovascular System
    • Examination of the Gastrointestinal System
    • Examination of the Neurological System
    • Examination of the Respiratory System
    • Examination of the Musculoskeletal System
    • Demonstration on putting on a surgical/ N95 mask properly
  • eLearning Materials of Individual Divisions
    • Cardiology
    • Clinical Pharmacology
    • Dermatology
    • Endocrinology
    • Gastroenterology & Hepatology
    • Geriatrics
      • Common Physical Signs in the Geriatric Setting
      • Commonly used Assessments in the Geriatric Setting
    • Haematology
    • Infectious Diseases
    • Nephrology
      • General Nephrology
      • Imaging
      • Peritoneal Dialysis
      • Hemodialysis
    • Neurology
    • Rehabilitation Medicine
      • Modified Ashworth Scale
      • Complex Regional Pain Syndrome
      • Case 1
      • Case 2
    • Respiratory Medicine
    • Rheumatology
      • Common Rheumatological Cases
      • Clinical Signs and Radiographs of Patients with Rheumatological Disorders
  • Credits
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Infectious Diseases

Cytomegalovirus Colitis

November 29th, 2014

Cytomegalovirus Colitis

History

  • 25 years old man
  • Underwent cadaveric liver transplant 6 weeks ago for hepatitis B related liver failure
  • Currently on oral prednisolone, cyclosporine A and entecavir
  • Prescribed with 2 weeks of cefotaxime and metronidazole
  • Currently still under ICU care
  • Developed watery stool and later melena few days ago

Physical Examination

  • Temperature 40°C
  • PR 120 bpm
  • BP 84/53mmHg
  • On ventilatory support
  • Mild rebound tenderness at the right iliac fossa
  • Noted to have melena in the diapers

Investigations

  • Hb 7.3g/dL
  • Platelet 53 x 109/L
  • WCC 18.5 x 109/L (neutrophils 10 x 109/L, lymphocytes 0.9 x 109/L)
  • Creatinine 81umol/L
  • Urea 8mmol/L
  • PT 15.3 seconds
  • ALT 323 U/L AST 218 U/L ALP 115 U/L GGT 26 U/L
  • Bil 84 umol/L
  • CXR: normal
  • OGD: normal

Differential Diagnosis

  • Clostridium difficile colitis
  • CMV colitis
  • Ischemic colitis
  • Ulcerative colitis
  • Crohn’s disease

Histological Specimens taken from Colonososcopy

Diagnosis

  • Colonoscopy was performed and showed presence of inclusion bodies, which stained positive for CMV viruses, confirming a diagnosis of CMV colitis.
  • Histology showed inclusion bodies
  • Positive staining for CMV viruses

Treatment

  • Intravenous ganciclovir 5mg/kg every 12 hours for 3 weeks
  • Renal function was closely monitored

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