Cytomegalovirus colitis in a woman with Sheehan syndrome

Cytomegalovirus (CMV) colitis is typically associated with impaired cellular immunity, but it is increasingly recognized in elderly individuals or those with subtle immune dysregulation.1,2 Sheehan syndrome, a form of postpartum hypopituitarism, results in chronic hormonal deficiencies and lifelong glucocorticoid replacement.3 Although not traditionally viewed as an immunosuppressive disorder, these endocrine alterations may nevertheless contribute to mild but clinically relevant immune vulnerability.4 Here we report a rare case of CMV colitis in a 70-year-old woman with long-standing Sheehan syndrome. A 70-year-old woman presented to the emergency department with a few-day history of right lower quadrant (RLQ) abdominal pain and diarrhea occurring more than three times per day. She denied fever, nausea, or vomiting. On physical examination, localized tenderness was noted over the RLQ; however, there was no McBurney’s point tenderness, rebound tenderness, or a positive Rovsing sign. Laboratory evaluation revealed leukocytosis of 10 100 cells/µL with 88.8% neutrophils and an elevated high-sensitivity C-reactive protein level of 10.92 mg/L. Plain abdominal radiography and abdominal computed tomography showed no remarkable abnormalities. There was no evidence of appendicitis or other acute surgical conditions. The patient was admitted for further evaluation of persistent abdominal pain and diarrhea.