Common mechanism of involvement: involvement of endothelial cells with vasculitis
Gastrointestinal involvement with CMV in a child with AIDS may include:
(1) esophagitis with ulceration, usually distal and at the gastroesophageal (GE) junction
(2) antral gastritis with ulceration and/or hypertrophic change at the pylorus with stenosis
(3) enteritis with perforation
(4) colitis with edema, ulcerations, strictures, pneumatosis, pseudomembranous enterocolitis, perforation, toxic megacolon and typhilitis (inflammation of terminal ileum and cecum)
The presence of two or areas of gastrointestinal involvement should suggest a CMV infection.
Clinical findings may include:
(1) abdominal pain, which may be generalized or localized (right lower quadrant, etc)
(2) peritonitis (following perforation)
(3) diarrhea
(4) fever
(5) weight loss
(6) GI bleeding
(7) abdominal cramping
Diagnosis of CMV infection can be done by:
(1) histologic or cytologic demonstration of intranuclear inclusions
(2) viral culture (shell vial, other) of biopsy or blood
(3) PCR
In AIDS the CMV may occur alone or combination with other enteric pathogens.
