Five Covid-19 patients have suffered cytomegalovirus-related rectal bleeding at a leading private facility here during the second wave of the pandemic, hospital authorities said on Tuesday and claimed it was being reported for the “first time” in immunocompetent persons. These patients face the problem on an average 20-30 days after the diagnosis of Covid-19, doctors at Sir Ganga Ram Hospital said.
Until now it affected only immunocompromised patients, post-transplant, cancer, AIDS, etc., but this is the “first time in India” that cases of CMV-related rectal bleeding in Covid immunocompetent patients have been reported, a spokesperson of the hospital said. According to Prof Anil Arora, chairman, Institute of Liver Gastroenterology and Pancreaticobiliary Sciences at the hospital, “During the second wave of the pandemic, in April-May, we have seen five cases of CMV infection in otherwise immunocompetent patients with COVID-19.” These patients presented with pain in abdomen and bleeding during stool discharge. None of them had other predisposing immunosuppressed states accounting for this viral infection, he said.
Covid infection itself and the medicines used for its treatment (like steroids), do suppress the immunity of patients and make them susceptible for uncommon infections with varied presentations, the hospital said in a statement. “One such opportunistic infection is from CMV Cytomegaloirus 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,” it said.
But in these five cases, all patients presented with “low lymphocyte count (6-10 per cent as against a normal of 20 to 40 per cent)”, indicating Covid-induced suppression of immunity predisposing them to symptomatic reactivation of CMV infection, doctors said. These patients in age group of 30-70, are from Delhi-NCR, and four had presented with lower gastrointestinal bleed, which is bleeding in stools and one of them presented with intestinal obstruction, the statement said.
“Two of them had massive bleeding, one requiring emergency life-saving surgery in the form of removal of right side of the colon, while one of them succumbed due to massive bleeding and severe Covid-19 chest disease,” the hospital said. Other three patients were successfully treated with antiviral therapy with ganciclovir, said Arora.
“Cytomegalovirus colitis was confirmed by 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 CMV infection by the specific immunohistochemistry stains,” said Dr Sunila Jain, senior consultant pathologist, at the hospital. In such cases a high index of suspicion and timely intervention in the form of an early diagnosis and effective antiviral therapy can save many a precious lives, opined Dr Praveen Sharma, senior consultant, gastroenterology department at the Sir Ganga Ram Hospital.