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"A Nightmare on Elm Street"
Catarina Gouveia, Catarina Gomes, Joana Torres, Elidio Barjas, Luísa Glória
Hospital Beatriz Ângelo
We present a case of a 77-year-old male, with past history of diabetes, hypertension and dyslipidemia. He presented with watery diarrhea, abdominal pain and fever for 1-week. Laboratory work-up showed elevated acute phase reactants (C-reactive protein of 40mg/dL and 17.000 white blood cells). Abdomino-pelvic CT-scan revealed parietal thickening of sigmoid and rectum. Stool cultures, ova and parasites test and C. difficile toxin were negative. Rectosigmoidoscopy showed severe colitis with deep ulcers thought-out proximal rectum and sigmoid colon. Biopsies showed deep mucosal ulceration and acute inflammatory infiltrate with positive Cytomegalovirus immunostaining. Patient was started on ganciclovir with clinical improvement.
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