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