Characteristic endoscopic findings and risk factors for cytomegalovirus-associated colitis in patients with active ulcerative colitis

Hirayama, Yutaka; Ando, Takafumi; Hirooka, Yoshiki; Watanabe, Osamu; Miyahara, Ryoji; Nakamura, Masanao; Yamamura, Takeshi; Goto, Hidemi

doi:10.4253/wjge.v8.i6.301

Cited by 36 publications

(32 citation statements)

References 44 publications

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“…Therefore, exclusion of CMV colitis is important before augmenting immunosuppressive therapy in refractory gastrointestinal irAE patients. Punched-out ulceration, which was shown in the present case, is one of the most common endoscopic characteristics of CMV colitis [14]. However, it has been unclear whether this punched-out ulceration would suggest CMV reactivation during the treatment of irColitis, because evidence on its endoscopic characteristics is scarce.…”

Section: Discussionmentioning

confidence: 54%

Cytomegalovirus Enterocolitis in a Patient with Refractory Immune-Related Colitis

Furuta

Miyamoto

Naoe

et al. 2020

Case Rep Gastroenterol

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Although most immune-related adverse events (irAEs) secondary to immune checkpoint inhibitors can be managed with immunosuppressive therapies; they can induce reactivation of infectious diseases, including cytomegalovirus (CMV). Here, we show a case of CMV enterocolitis during steroid therapy for an irAE. A 77-year-old man with unresectable malignant melanoma was treated with ipilimumab. He suffered from immune-related colitis (irColitis) and was treated with methylprednisolone. Although corticosteroids initially improved his symptoms, CMV reactivation occurred and colitis was exacerbated. Antiviral therapy improved his symptoms without augmenting the immunosuppressive therapy. CMV colitis should be considered when a patient with irColitis shows resistance to immunosuppressive therapy.

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Section: Discussionmentioning

confidence: 54%

Cytomegalovirus Enterocolitis in a Patient with Refractory Immune-Related Colitis

Furuta

Miyamoto

Naoe

et al. 2020

Case Rep Gastroenterol

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“…Another 22 articles were further excluded by reading the full text. Ultimately, 20 [9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] articles were eligible for data extraction and meta-analysis. The searching process is shown in Fig.…”

Section: Search Resultsmentioning

confidence: 99%

“…Patients with UC are more susceptible suffered from cytomegalovirus (CMV) infection due to decreased intestinal immune function and glucocorticoid or immunosuppressive therapy, which not only results in complicated clinical manifestations, but also increases the di culty of diagnosis and treatment of the disease [6,7]. The study shows that the probability of CMV infection or reactivation in UC population is between 15.8% and 34.0% [8].CMV is an opportunistic virus, which has been biologically characterized by latency and activation [7].CMV infection or reactivation could signi cantly prolong the hospitalization period, increase the Corticosteroids dependence rate, operation rate and mortality [9]. The reason may be that CMV infection or reactivation could aggravate the in ammatory response and immune process, exacerbating colon damage [10].…”

Section: Introductionmentioning

confidence: 95%

Risk factors of cytomegalovirus infection or reactivation in ulcerative colitis patients

Qin¹,

Dejun²,

Wang³

et al. 2020

Preprint

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Background To identify the risk factors for cytomegalovirus (CMV)infection or reactivation in ulcerative colitis (UC) patients. Method PubMed, Cochrane Library, EMBASE, Web of Science and CNKI were retrieved from the inception of electronic databases to February 2020. All analyses were performed using Stata/SE 15.1 version (StataCorp). Result 22 papers were included. There was significant difference in severe UC (OR = 1.465, 95% CI: 1.107 to 1.939, P = 0.008), pancolitis (OR = 2.108, 95% CI: 1.586 to 2.800, P = 0.0001), age of onset (MD = 6.212, 95% CI: 2.552 to 9.971, P = 0.001), glucocorticoid (OR = 4.175, 95% CI: 3.076 to 5.666, P = 0.001), immunosuppressant (OR = 2.038, 95% CI: 1.259 to 3.301, P = 0.004), 5-ASA (OR = 0.674, 95% CI: 0.492 to 0.924, P = 0.014). However, no significant difference was detected in disease duration, infliximab. Conclusion Severe UC, pancolitis, glucocorticoid, immunosuppressive therapy and age of onset are the risk factors of CMV infection or reactivation in UC patients, we should closely monitor if UC patients with the above indicators and give timely symptomatic treatment to prevent the disease from worsening.

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“…However, the existence of ulcerative lesions in UC patients refractory to immunosuppressive therapies may suggest the possibility of HCMV infection. Endoscopic findings such as punched-out ulcers, longitudinal ulcers, diffuse mucosal defect, and geographic ulcers ( Figure 2) have been reported to be characteristics of UC complicated by HCMV infection [13,14]. However, it is clinically difficult to diagnose HCMV colitis only by endoscopic findings [15,16] and it remains necessary to prove the HCMV infection.…”

Section: Methods For Diagnosis Of Hcmv Infections In Ulcerative Colitmentioning

confidence: 99%

Current Diagnostic and Therapeutic Approaches to Cytomegalovirus Infections in Ulcerative Colitis Patients Based on Clinical and Basic Research Data

Yokoyama

Yamakawa

Hirano

et al. 2020

IJMS

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Human cytomegalovirus (HCMV) is a ubiquitous herpesvirus (the human herpesvirus 5) and an opportunistic pathogen that primarily infects HIV-positive and other immuno-compromised patients. Retrospective studies in the field of inflammatory bowel disease (IBD) have suggested a relationship between a concomitant colonic HCMV infection and poor outcomes in patients with an ulcerative colitis (UC) due to the presence of HCMV in surgical specimens of patients with a toxic megacolon or a steroid-resistant UC. Therefore, gastroenterologists have focused on the contribution of HCMV infections in the exacerbation of UC. Numerous studies have addressed the benefits of treating colonic HCMV reactivation in UC using an antiviral treatment. However, its clinical relevance remains uncertain as only a few prospective studies have assessed the direct relationship between clinical outcomes and the viral load of HCMV in colonic tissues. HCMV reactivation can be triggered by inflammation according to fundamental research studies. Thus, optimal control of intestinal inflammation is essential for preventing an HCMV reactivation in the intestinal mucosa. Indeed, several reports have indicated the effectiveness of an anti-tumor necrosis factor-alpha (TNFα) treatment in patients with an active UC and concomitant HCMV infections. In this review, we describe the mechanism of HCMV reactivation in UC cases and discuss the current issues regarding diagnosis and treatment of HCMV infections in UC patients.

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Characteristic endoscopic findings and risk factors for cytomegalovirus-associated colitis in patients with active ulcerative colitis

Abstract: Identification of a total corticosteroid dose > 400 mg for 4 wk, extensive colitis and a specific endoscopic finding of punched-out ulcer might facilitate the more rapid diagnosis and timely initiation of antiviral therapy for CMV-associated colitis in patients with active UC.

Cited by 36 publications

References 44 publications

Cytomegalovirus Enterocolitis in a Patient with Refractory Immune-Related Colitis

Cytomegalovirus Enterocolitis in a Patient with Refractory Immune-Related Colitis

Risk factors of cytomegalovirus infection or reactivation in ulcerative colitis patients

Current Diagnostic and Therapeutic Approaches to Cytomegalovirus Infections in Ulcerative Colitis Patients Based on Clinical and Basic Research Data

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