Cytomegalovirus infection and Rectovaginal Fistula associated with Ulcerative Colitis: Report of a Case

Yoshifumi Shimada, Tsuneo Iiai, Satoshi Maruyama, Tatsuo Tani and Katsuyoshi Hatakeyama

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences

We report the case of patient with cytomegalovirus infection and rectovaginal fistula associated with ulcerative colitis. A 40-year-old woman was diagnosed with ulcerative colitis of left-sided colitis 4 years earlier. Her clinical course was relapse-remitting type. She was relapsed, and received steroid injection therapy and leukocytapheresis. After then, she had defecation from vagina. Double contrast study of the colon and rectum revealed rectovaginal fistula. Colonoscopy showed geographical ulcer and peripheral blood cytology showed CMVpp65 positive cells. Deep ulceration created by cytomegalovirus infection seems a possible cause of rectovaginal fistula. Her activity of ulcerative colitis was improved after antivirus treatment by ganciclovir. We conducted diverting sigmoid colostomy for rectovaginal fistula. Eight months later, she was underwent total colectomy, ileal pouch anal anastomosis and setting of diverting ileostomy. Rectovaginal fistula should be taken into account in cases of ulcerative colitis with cytomegalovirus infection.

Key words
cytomegalovirus infection, rectovaginal fistula, ulcerative colitis

Reprint requests
Yoshifumi Shimada Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences
1-757 Asahimachi-dori, Chuo-ku, Niigata, 951-8510 JAPAN

Accepted
September 24, 2008

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