Background
Cytomegalovirus (CMV) is a double-stranded deoxyribonucleic acid virus belonging to the Herpesviridae family. 1 It is more commonly seen in individuals with immunosuppressive diseases, including inflammatory bowel disease (IBD), hematological malignancy, organ transplantation, acquired immunodeficiency syndrome (AIDS), or therapies such as cancer, and corticosteroids. 2 However, most of the CMV-related infections in immunocompetent individuals go undetected, 3 and presented as fever, sometimes with pancytopenia. Diarrhea (watery and bloody in severe cases) may begin to develop as an inflammatory response. Ulcerative changes can be seen when the colon tissue affected by CMV.
Subsequently, inflammatory polyps may develop, which, rarely, may cause colon obstruction. Severe inflammation and vasculitis may lead to bowel perforation and peritonitis due to ischemia and transmural necrosis. 4 We describe a case of COVID-19 pneumonia on immunosuppressive treatment presenting with lower gastrointestinal bleeding due to CMV colitis confirmed by histopathology.