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CMV Proctitis — SCE Infectious Diseases MCQ

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ModerateHIV MedicineCMV ProctitisSCE Infectious Diseases

A 35-year-old man presents with rectal bleeding and tenesmus. He is MSM and HIV positive. Proctoscopy shows proctitis with mucosal ulceration. Rectal biopsy shows intranuclear inclusions in colonic epithelial cells. CMV PCR from the biopsy is positive. Rectal NAAT for Chlamydia and Gonorrhoea is negative. What is the diagnosis?

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Correct answer: C — CMV proctitis

CMV proctitis presenting with rectal bleeding, tenesmus, and mucosal ulceration in an HIV-positive MSM, with intranuclear inclusions (owl-eye bodies) on biopsy and positive tissue CMV PCR is diagnostic. This is distinct from sexually transmitted proctitis (LGV, gonorrhoea, syphilis — all excluded here). Treatment is IV Ganciclovir 5 mg/kg BD for 21 days (or Valganciclovir 900 mg BD if able to tolerate oral). ART optimisation is essential for long-term management.

Reference: BHIVA 2022 – OI guidelines; NICE 2024 – CMV