In what is claimed to be the first such post-Covid complication during the second wave of the pandemic, five cases of Cytomegalovirus (CVM)-related rectal bleeding were diagnosed in patients with Covid-19 at Delhi’s Sir Ganga Ram Hospital on Tuesday.
Professor Anil Arora, Chairman, Institute of Liver Gastroenterology and Pancreaticobiliary Sciences at the hospital said “We have seen five cases of CMV infection in otherwise immunocompetent patients with Covid-19 during the second wave of the pandemic. All these patients visited the hospital complaining of abdomen pain and bleeding in stools and none of them had other predisposing immunosuppressed states accounting for this viral infection.”
Dr Arora said that CVM is a common virus and found commonly in 80 per cent of the population.
“The virus exists in 80 to 90 per cent 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,” he said.
Explaining the reason due to which the virus gets activated in the body, he said “Covid infection and the medicines used for its treatment (steroids) lower the immunity of patients and make them susceptible for unfamiliar infections with varied presentations. One such infection is the CMV virus. It can affect any internal organ including brain and lungs as well.”
Dr Arora further said that all patients presented with low lymphocyte count (6-10 per cent as against a normal of 20 to 40 per cent) in our series indicating covid induced suppression of immunity predisposing them to symptomatic reactivation of CMV infection.
“Out of five cases, four had presented with lower gastrointestinal bleed and one patient presented with intestinal obstruction. Two of them had massive bleeding, one requiring emergency lifesaving surgery in the form of removal of the right side of the colon and one of them had succumbed due to massive bleeding and severe Covid chest disease. Other three patients were successfully treated with antiviral therapy with ganciclovir,” said Dr Arora.
Dr Sunila Jain, Senior Consultant Pathologist at the hospital said that Cytomegalovirus colitis was confirmed by Polymerase chain reaction (PCR) testing for CMV viremia and tissue biopsy from the large intestine which showed intranuclear inclusion bodies which was further confirmed to be due to infection by the specific immunohistochemistry stains.