Cytomegalovirus enterocolitis complicated by perforated appendicitis in a premature infant.

A 9-week-old, former 30-week estimated gestational age premature infant had recurrent episodes of abdominal distention. Laparotomy revealed partial small bowel obstruction caused by ileocecal inflammation with stenosis, and a perforated appendix with fistulization into the cecum. The resected appendix and ileocecal junction showed intranuclear and intracytoplasmic viral inclusions, and were cytomegalovirus positive by immunoperoxidase staining, which implicated cytomegalovirus as the etiology of the recurring bouts of enterocolitis with appendicitis. Cytomegalovirus is frequently overlooked in the differential diagnosis of enterocolitis and chronic gastrointestinal symptoms in infants, but should be included as in older immunocompromised patients.