Most cases of CMV colitis occur in immunocompromised patients such as those with congenital or acquired immunodeficiency disease, those receiving immunosuppressive drugs, and those who have undergone transplantations.¹ However, in rare cases, CMV colitis can also occur in immunocompetent hosts and can cause significant morbidity and mortality.¹ CMV colitis in immunocompromised patients is usually secondary to the reactivation of latent infection, whereas its occurrence in immunocompetent hosts is usually related to primary infection.² Abdominal pain, diarrhea, and fever are the common presenting symptoms of CMV colitis.³ A retrospective study of 12 immunocompetent adults with CMV colitis reported that well-demarcated ulcerations (50%), ulceroinfiltrative growth (25%), and pseudomembrane formation (25%) were the most commonly identified endoscopic abnormalities.⁴ In agreement, the endoscopic findings of this case reported a well-demarcated ulceration. The diagnosis of CMV colitis is based on serology, CMV antigen testing, and colonscopy with biopsy.⁵ The pathologic findings distinctly indicated CMV colitis, as they revealed viral inclusions of the Cowdry owl eye inclusion bodies characteristic of CMV.⁶ The ulcer biopsy of this case showed inflammation of the granulation tissue with occasional CMV-like viral inclusions (Fig. E, F). In addition, simple haematoxylin and eosin staining revealed a few scattered positive cells, representing CMV colitis. Most cases of CMV infection in immunocompetent hosts are associated with minimal or no symptoms, and antiviral therapy is not usually recommended.⁶ However, several case reports have documented successful therapy for immunocompetent hosts with severe manifestations of CMV infection.^4,6 In our case, the patient was treated with an antiviral therapy (ganciclovir), as she suffered from severe abdominal pain and had a large ulceration, as observed on colonoscopy. After 2 weeks of antiviral therapy, the patient's condition clinical symptoms resolved, and on follow-up colonoscopy, the large ulceration had resolved and the CMV-like viral inclusions were absent on histology (Fig. F, G). The antiviral therapy with ganciclovir appears appropriate for severe CMV colitis even in immunocompetent hosts. This case study showed that despite aggressive clinical manifestation, an immunocompetent host has a good prognosis of CMV colitis, if the infection is diagnosed and treated early.