Ileum perforation due to cytomegalovirus infection in a patient with adult T‐cell leukemia

Case A 73‐year‐old woman was transferred to our department due to severe abdominal pain with peritonitis. Her laboratory data showed that her white blood cell count was elevated to more than 50,000/mm 3 . Antibodies to HTLV ‐ I were positive and we made the diagnosis of adult T‐cell leukemia ( ATL ). Outcome Emergency laparotomy was performed and revealed two separate small perforations of the ileum, requiring bowel resection. Immunohistochemistry for cytomegalovirus ( CMV ) antigen revealed positive staining in the intestinal stromal cells. Despite surgery and antiviral therapy with ganciclovir, she died after 28 days. Conclusion Adult T‐cell leukemia patients may present acute abdominal pain due to intestinal perforation caused by CMV infection. We should be aware of CMV infection as one of the pathogens causing acute abdominal crises such as massive hemorrhage or visceral perforation.