Acute Perforation of a Prior Small Bowel Anastomosis Secondary to CMV Enteritis in a Newly-Diagnosed AIDS Patient

Cris Malino; Brian Diskin; Weiguo Liu

Poorly controlled human immunodeficiency virus (HIV) infection can result in progression to acquired immunodeficiency syndrome (AIDS). Opportunistic infection in AIDS patients can be severe, resulting in life-threatening encephalitis, meningitis, retinitis, esophagitis, and enteritis. 

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Here, we describe the unusual case of a 50 year-old male with newly diagnosed AIDS presenting to the ER with pneumoperitoneum and sepsis secondary to perforation at his prior small bowel anastomotic site due to Cytomegalovirus.

While undergoing workup for weight loss, an EGD revealed esophageal ulcerations. Biopsies were consistent with CMV. Serum CMV showed 1,319 copies/mL. These findings were followed with a positive HIV-1 antibody test. Notably, the patient had a history of a small bowel obstruction, 35 years prior, requiring exploratory laparotomy, small bowel resection and ostomy creation (status post subsequent reversal).  He presented to our urban academic medical center with abdominal pain and fevers and was found to have pneumoperitoneum and perforation of his prior small bowel anastomosis. After resection and ileostomy formation, the pathology revealed active cMV on immunohistochemical stains. 

The report includes relevant and imaging and literature review on this rare presentation. In patients with immunosuppression, CMV related perforation should be considered amongst surgeons and pathologists. Infectious disease specialists should be included in treatment.