A case of small intestinal perforation due to cytomegalovirus infection in a patient with churg-strauss syndrome

A 70-year-old woman with Churg-Strauss syndrome had been treated by prednisolone and cyclophosphamide for a month. She began to complain of abdominal pain. She was given steroid-pulse treatment, because her physician thought that the abdominal pain was due to worsening Churg-Strauss syndrome. A colonoscopic examination was performed. On the day following the examination, she complained of severe abdominal pain which spread to the whole abdomen. An abdominal CT scan showed extra-intestinal free air. Emergency operation was performed with a diagnosis of intestinal perforation. The operation revealed four ulcerations in the ileum, about 120 cm to 210 cm distally from the ligament of Treitz. We performed partial resection of about 100 cm of the ileum, and also performed enterostomy. The pathological study disclosed that the perforation was caused by cytomegalovirus enteritis. In the treatment of intestinal perforation in the immunosuppressive patient, we suspect the presence of cytomegalovirus enteritis therefore early administration of antiviral agent is desirable.