Severe Cytomegalovirus Infection Masquerading as Recurrent Ischemic Colitis in a Patient with End-Stage Renal Disease

He returned with the same symptoms 10 days later. Abdominal CT was repeated. Colonoscopy showed circumferential ulcerated mucosa with grayish discoloration and sloughing of the mucosa starting at the hepatic flexure and extending proximally, potentially due to ischemic colitis (Figure 1). There was a sharp demarcation between the normal and ulcerated mucosa. A colonic biopsy at the edge of the demarcation showed non-specific small ulcerations without any indication of cytomegalovirus (CMV). Human immunodeficiency virus screening was negative. The patient improved again with conservative management. No CMV polymerase chain reaction was done given the patient’s clinical improvement.