Abstract Ovarian and fallopian tube cytomegalovirus (CMV) infection is a rare finding, reported mostly in autopsy studies of immunocompromised patients. We report here a case of CMV salpingitis in a 22-year-old female, with Crohn's disease and on immunosuppressive drugs. The fallopian tube involvement by CMV infection was an incidental finding during resection of a large, matted mass involving the appendix, right ovary and right fallopian tube with bowel perforation and abscess formation. Review of literature revealed that most cases of CMV involving the fallopian tube have concurrent CMV oophoritis in pre- and post- menopausal women having pelvic inflammatory disease (PID). We concluded that fallopian tube can be involved by CMV infection in an immunocompromised patient. Keywords: Cytomegalovirus, Salpingitis, Inflammatory bowel disease. Introduction Cytomegalovirus (CMV) infection has been described in female genital tract in a few case reports. Friedmann et al 1 have described disseminated CMV infection of female genital tract involving the vulva, vagina and cervix in immunocompromised patients. CMV inclusion bodies have been described in recurrent ulcerative vaginal lesions. Cases of CMV endometritis and cervicitis have also been reported. 1-4 Involvement of ovaries has also been reported by several authors. 5- 7 To date, more than 10 cases of CMV oophoritis have been reported in the literature. Review of literature revealed that most CMV salpingitis cases have concurrent CMV oophoritis in pre- and post- menopausal women having pelvic inflammatory disease (PID). While age-related vasculopathy was thought to be a causative mechanism for CMV oophoritis, observation of inflammation mediated microthrombosis provides an evidence of age- independent mechanism, suggesting that restrictive and obstructive vascular changes can be involved in the pathogenesis of CMV infection. Myerson et al 8 studied widespread presence of histologically occult CMV in situ hybridization (ISH) in formalin-fixed paraffin-embedded tissue sections and detected occult infection in normal appearing cells like cardiac myocytes, hepatocytes, spleen, lymph node reticular cells, endometrial stromal, glandular cells, breast stromal cells, cells of renal glomerulus, tubule and interstitium, adrenal cortex and medulla, fallopian tube submucosa, myometrium and anterior pituitary. There have been increasing number of case reports on inflammatory bowel disease (IBD) complicated by CMV. The role of CMV in the pathogenesis of IBD is debatable. Most studies suggest a role for a latent or active CMV infection in causing exacerbations of IBD, particularly in association with severe or refractory cases under corticosteroid and/ or immunosuppressive therapy. CMV can be found in both blood and intestines of patients with IBD. The role of CMV in steroid refractoriness remains unknown. Studies also suggest that CMV infection exacerbates IBD refractory to immunosuppressive therapies. It is imperative that concurrent CMV infection be considered in IBD patients with active colitis, especially in an immunosuppressed host. Case Presentation A 22-year-old Saudi female presented with right abdominal pain for the last two months, with history of anorexia and weight loss. The patient was a known case of Crohn's disease for two years, treated with steroids and eight cycles of infliximab. Clinical examination showed that the right flank mass was suspected to be malignant. Computerized tomography was done which showed a right adnexal mass. The patient underwent right salpingo-oophorectomy and an appendectomy. On gross examination, the specimen consisted of an irregular, tan coloured, matted mass measuring 11.0 x 6.0 x 3.0 cm. Outer surface showed congestion and marked adhesions. On sectioning, it was solid and cystic J Pak Med Assoc 780 1 Airbase Military Hospital, Al Khobar, 2,5 King Abdul Aziz Specialist Hospital, Taif, 3,4 King Fahad Specialist Hospital, Dammam, KSA. Correspondence: Dalal Nemenqani. Email: dnemenqani@hotmail.com CASE REPORT Histopathological features of an incidental case of cytomegalovirus salpingitis in a patient with inflammatory bowel disease Wesal Al Rabih Fpathfu, 1 Yaqoob Nausheen, 2 Rabab Alottas Fpathkfu, 3 Ahmed Al Khudairi, 4 Dalal Nemenqani 5