BACKGROUND: Cytomegalovirus infection is associated with significant morbidity and mortality in immunocompromised patients, but its impact on immunocompetent patients is still poorly understood. Furthermore, there is increasing evidence implying that chronic infection may contribute to a heightened cardiovascular risk. CASE PRESENTATION: We describe the case of incidental diagnosis of Cytomegalovirus proctitis in an immune-competent white British elderly gentleman, admitted following a stroke and investigated for rectal cancer following the development of bloody diarrhoea and persistent systemic inflammatory response. CONCLUSION: This raised some several interesting points; firstly that we must revise our approach to investigating the immunocompetent elderly patient, secondly, could chronic Cytomegalovirus infection have contributed to the presentation of stroke in this patient and lastly what are the existing evidence for treatment in this population? We use this opportunity to try and address some of these questions and feel that this would be of benefit to the wider audience.We discuss the risk factors for disease in immune-competent patients and also a brief overview of the benefits of treatment in this population.
Cytomegalovirus Infections/virology , Cytomegalovirus/physiology , Immunocompetence , Proctitis/virology , Rectal Neoplasms/diagnosis , Aged , Cytomegalovirus Infections/diagnostic imaging , Cytomegalovirus Infections/pathology , Diagnosis, Differential , Humans , Male , Proctitis/diagnostic imaging , Proctitis/pathology , Radiography, Abdominal , Rectal Neoplasms/pathology , Tomography, X-Ray Computed
We present a case of a 72-year-old man who presented with fluctuating right-sided weakness and numbness. This was characterised by episodic sudden onset weakness with resolution of symptoms in between. His symptoms and signs were becoming persistent despite the addition of dual antiplatelet therapy. The history we describe is classical of capsular warning syndrome. The patient went on to have further definitive neuroimaging which revealed a pontine infarct, rather than the expected capsular infarct. We discuss the importance of capsular warning syndrome, the proposed pathophysiological mechanisms and different locations of infarction in previous cases of capsular warning syndrome. We also discuss the lack of consensus (within the literature) in treatment options which are used to try and prevent a completed stroke occurring in cases of capsular warning syndrome.
Ischemic Attack, Transient/diagnosis , Aged , Humans , Male , Syndrome
