Hidden Tunnel: A Case of Duodenal-Colonic Fistula Caused by Cytomegalovirus.

ABSTRACT

We present the case of an 86-year-old African American gentleman who presented with fatigue, diarrhea, and weight loss. He had elevated liver enzymes in an obstructive pattern. A magnetic resonance cholangiopancreatography scan showed edema around the stomach and duodenum, which prompted evaluation with an esophagogastroduodenoscopy. A large enteric fistula between the duodenum and colon was visible, and biopsies returned positive for cytomegalovirus (CMV). The patient did not have any known risk factors for immunodeficiency and was successfully treated with medical therapy. Our case is unique in the severity of CMV infection in an otherwise healthy individual.