• Khee-Siang Chan, Chun-Chieh Yang, Chin-Ming Chen, His-Hsing Yang, Ching-Chien Lee, Yin-Ching Chuang, and Wen-Liang Yu.
• Department of Intensive Care Medicine, Chi Mei Medical Center, Tainan City, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
• J Crit Care. 2014 Jun 1;29(3):474.e1-6.

PurposeCytomegalovirus (CMV) infection occurs increasingly in critically ill patients in intensive care units (ICUs). We reported CMV colitis which has rarely been recognized in the ICU patients.MethodsCMV DNA was detected by polymerase chain reaction (PCR) for blood and/or stool samples. Definite diagnosis of CMV colitis required histopathology or CMV immunohistochemical staining of colorectal biopsies. We reviewed ICU patients characterized by positive blood or stool CMV-PCR with colorectal bleeding or water diarrhea.ResultsWe identified 18 patients (biopsy-proved, n=8; probable cases, n=10). The most common comorbidities were chronic renal disease, diabetes mellitus, and coronary artery disease. Stool CMV-PCR was positive in 7 of 10 patients (2 of 3 biopsy-proved and 5 of 7 probable cases). Colonoscopy was performed for 15 patients, revealing ulcerative or polypoid lesions. The endoscopists obtained colonic biopsies from 9 patients. Yet, the pathologists reported CMV colitis for 4 patients. Additional 4 patients were confirmed using immunohistochemical stain by the request of clinical physicians. Pseudomembranous colitis was found in 4 patients.ConclusionDiagnosis of CMV colitis seems difficult in clinical practice and need persistent communication between clinicians. The positive stool CMV-PCR result was a useful hint for adding immunohistochemical stain in mucosal biopsies to make a definite diagnosis of CMV colitis.Copyright © 2014 Elsevier Inc. All rights reserved.

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