Pseudoneoplastic Appearance of Cytomegalovirus Infection Mimicking Colon Carcinoma in Two Immunocompetent Patients

A 57 year-old male presented with fever, diarrhea, hematoquezia, weight loss and right lower quadrant pain. Found to have elevated CEA (5.7 ng/mL) and CMV IgG antibodies (68 AU/mL). Colonoscopy revealed a large ulcerated, necrotic mass, near completely obstructing the cecum (Figure 1a). Biopsies with CMV immuno-stain were positive for CMV induced colitis. Abdominal CT scan showed focal circumferential wall thickening (up to 1.4 cm) in the cecum, with extension into the proximal ascending colon and ileocecal valve. • CMV infection of the gastrointestinal tract with lesions mimicking carcinoma have been reported mainly in immunocompromised hosts. • In this report we present two patients immunocompetent with CMV colitis associated with pseudotumors of the colon that completely resolved with antiviral therapy. • In immunocompetent subjects, active CMV infection is rare and can result either from endogenous reactivation of CMV or from exogenous reinfection with another virus strain. The frequency of CMV reactivation increases with age and co-morbidities. • Although CMV colitis with pseudoneoplastic appearance is very rare in immunocompetent patients, it should be suspected and excluded since it responds very well to antiviral therapy. • Patient 2