BACKGROUND: Gastrointestinal involvement by cytomegalovirus (CMV) infection is a well recognised complication in patients taking steroid/immunosuppressive therapy or suffering from immunodeficiency and debilitating diseases. Rarely, CMV may affect immunocompetent healthy individuals. However, CMV infection presenting as isolated inflammatory polyps is unusual. METHODS: We describe five patients (1 infant and 4 adults 56-80 years of age) with CMV-associated polyps that posed diagnostic difficulty. Four lesions were initially misdiagnosed as inflammatory fibroid polyp (n = 2), atypical/suspicious lymphoproliferative (n = 1) and mesenchymal (n = 1) lesion. RESULTS: Underlying diseases were kidney transplantation (1), ulcerative colitis (1), and HIV infection (1). One elderly patient had pseudomembranous colitis but no significant co-morbidity. One patient had no relevant diseases. The lesions affected the colon (3), small intestine (1) and gastric antrum (1); one was multifocal. The size ranged from 0.3 cm to 2.0 cm. Histologically, all lesions showed extensive surface ulceration and abundant capillary-rich granulation tissue containing activated lymphoid cells, plasma cells, granulocytes, enlarged histiocytes and atypical fibroblasts. Eosinophils were prominent in two cases. Immunohistochemistry showed unequivocal intranuclear CMV inclusions. CONCLUSION: These cases widen the spectrum of endoscopic and histological appearance of gastrointestinal CMV infection. Awareness of these unusual lesions should enhance detection and proper classification of this probably under-recognised CMV presentation.
BACKGROUND: Gastrointestinal involvement by cytomegalovirus (CMV) infection is a well recognised complication in patients taking steroid/immunosuppressive therapy or suffering from immunodeficiency and debilitating diseases. Rarely, CMV may affect immunocompetent healthy individuals. However, CMV infection presenting as isolated inflammatory polyps is unusual. METHODS: We describe five patients (1 infant and 4 adults 56-80 years of age) with CMV-associated polyps that posed diagnostic difficulty. Four lesions were initially misdiagnosed as inflammatory fibroid polyp (n = 2), atypical/suspicious lymphoproliferative (n = 1) and mesenchymal (n = 1) lesion. RESULTS: Underlying diseases were kidney transplantation (1), ulcerative colitis (1), and HIV infection (1). One elderly patient had pseudomembranous colitis but no significant co-morbidity. One patient had no relevant diseases. The lesions affected the colon (3), small intestine (1) and gastric antrum (1); one was multifocal. The size ranged from 0.3 cm to 2.0 cm. Histologically, all lesions showed extensive surface ulceration and abundant capillary-rich granulation tissue containing activated lymphoid cells, plasma cells, granulocytes, enlarged histiocytes and atypical fibroblasts. Eosinophils were prominent in two cases. Immunohistochemistry showed unequivocal intranuclear CMV inclusions. CONCLUSION: These cases widen the spectrum of endoscopic and histological appearance of gastrointestinal CMV infection. Awareness of these unusual lesions should enhance detection and proper classification of this probably under-recognised CMV presentation.