Cytomegalovirus Limited to the Rectum in an Immunosuppressed IBD Patient

To the Editors, A 43-year-old female with 23 years history of procitits treated with oral mesalamine and azathioprine presented to another hospital with a few months of 4 to 5 bloody bowel movements/day, fecal incontinence, and tenesmus. Endoscopy showed Mayo 2 inflammation up to 20 cm from the anal verge. Histology was compatible with IBD. She did not respond to optimization of oral + topical aminosalicylates (5-ASA) nor to 60 mg/day of prednisone with continued azathioprine. Consequently, she was planned to initiate anti-TNF, at which time point she presented to our clinic. Workup revealed elevated c-reactive protein (CRP; 3–4 times the upper limit of normal), hemoglobin of 12.8 g/dL, and adequate 6-thioguanine nucleotides (TGN) level (286 mcg/108 red blood cells). Polymerase chain reaction (PCR) panel for sexually transmitted disease organisms was negative. Given severe refractory proctitis, lower endoscopy was reperformed (Figure 1A), disclosing severe inflammation, with Mayo...