Delhi Hospital releases first report on rectal bleeding due to CMV virus in COVID patients

In a major development, a Delhi Hospital released its first report of five cases of Cytomegalovirus (CVM) related rectal bleeding in COVID immunocompetent patients. "These patients came with abdominal pain and bleeding in stools nearly 20-30 days after the diagnosis of COVID," said Professor Anil Arora of Sir Ganga Ram Hospital. 

Professor Arora further explained and said, "During the second wave of the COVID-19, in Apr-May 2021 we have seen five cases of CMV infection in otherwise immunocompetent patients with COVID-19. These patients presented with pain abdomen and bleeding in stools. These patients presented with a mean of 20 to 30 days after the diagnosis of Covid. None of them had other predisposing immunosuppressed states accounting for this viral infection."

'CVM exists in 80 to 90% of Indian population' 

In an official press release, Sir Ganga Ram Hospital stated, "The COVID infection itself and the medicines used for its treatment (steroids) do suppress the immunity of patients and make them susceptible to uncommon infections with varied presentations. One ‘such opportunistic infection is (CMV) virus. Cytomegalovirus exists in 80 to 90 % of the Indian population in asymptomatic form as our immunity is strong enough to make it clinically asymptomatic. Clinical presentation with symptoms secondary to CMV is usually seen in patients whose immunity is compromised."

"But in our series all patients presented with low lymphocyte count (6-10% as against a normal of 20 to 40%) indicating covid induced suppression of immunity predisposing them to symptomatic reactivation of CMV infection," it added. 

"Out of five cases with the age group of 30-70 years were from Delhi NCR, four had presented with a lower gastrointestinal bleed that is bleeding in stools, and one patient presented with intestinal obstruction. Two of them had a massive bleed, one requiring emergency lifesaving surgery in the form of removal of the right side of the colon and one of them has succumbed due to massive bleeding and severe Covid chest disease. Other three patients were successfully treated with antiviral therapy with ganciclovir," said Prof. Anil Arora.

Cytomegalovirus colitis was confirmed by PCR testing for CMV viremia and tissue biopsy from the large intestine which showed intranuclear inclusion bodies which were further confirmed to be due to CMV infection by the specific immunohistochemistry stains," informed Dr Sunila Jain, Senior Consultant Pathologist of Sir Ganga Ram Hospital.