Cytomegalovirus (CMV)-associated diseases remain a major problem in transplant recipients. Early diagnosis is critical. Presentation of early CMV
colitis can be mild and nonspecific in transplant recipients. Although serology is helpful in the diagnosis, sometimes it is inadequate. Because the endoscopic features of CMV
colitis are specific, colonoscopy facilitates the histopathologic examination. We present the clinical properties and advantages of early colonoscopy in transplant recipients with CMV
colitis. The study group included seven patients (six men, one woman of mean age, 36.7 years (range, 22 to 64 years) whose mean transplant duration was 12.3 months (range, 1 to 72 months). Six of the seven patients experienced an acute graft rejection treated with high doses of
steroids; one patient had a
herpes simplex virus infection. All patients were on
steroid treatment with a various combinations of
immunosuppressive agents, including
cyclosporine,
mycophenolate mofetil, and
tacrolimus. All patients presented with mild
diarrhea without any blood or mucous discharge. Four patients had
fever exceeding 38 degrees C; two had
abdominal pain. Stool examinations revealed normal findings in six patients, while one patient had white blood cells and amoebic
cysts. Serum CMV
IgM and CMV pp65 antigenemia were negative in five of seven patients and two had positive results. All patients showed typical colonoscopic and histopathologic findings compatible with CMV
colitis. Standard
ganciclovir treatment was successful in all patients. Early and rapid colonoscopy is beneficial for the early diagnosis and management of CMV
colitis in transplant recipients.