Colitis due to Cytomegalovirus and Herpes Simplex Type 2 as a Complication of a First Presentation of Inflammatory Bowel Disease

Abstract

<b><i>Introduction:</i></b> The first presentation of ulcerative colitis may be an acute flare in about 15% of patients, requiring hospital admission. In acute severe steroid-refractory ulcerative colitis, cytomegalovirus (CMV) should be sought because it is a frequent cause of refractory disease. Herpes simplex colitis constitutes a rarer event in ulcerative colitis patients and it is usually associated with immunosuppression. <b><i>Case Presentation:</i></b> We report a case of a first presentation of ulcerative colitis complicated by CMV and herpes simplex type 2 coinfection. After a long period of systemic corticosteroids, the diagnosis of both CMV and herpes colitis was made. Despite antiviral treatment, colectomy was required due to a contained perforation. <b><i>Discussion/Conclusion:</i></b> This report highlights the importance of a high degree of suspicion for opportunistic infections in steroid/immunomodulator refractory ulcerative colitis, even in the first flare.

Herpes simplex virus colitis mimicking acute severe ulcerative colitis: a case report and review of the literature

“…All patients presented with symptoms suggestive of acute severe UC, and initial treatment consisted of corticosteroids followed by cyclosporine [ 4 ], anti-tumor necrosis factor-inhibitors [ 7 ], or combination therapy with tacrolimus and azathioprine [ 3 ]. The diagnosis of HSV colitis was made on biopsy in only one case [ 6 ] and similar to our case, bowel perforation with subsequent surgery occurred in three patients and HSV was therefore detected with delay [ 5–7 ]. In three cases, HSV-2 was found [ 6 , 8 , 9 ]; in the remaining patients, the genotype was not characterized [ 3–5 , 7 ].…”

“…The diagnosis of HSV colitis was made on biopsy in only one case [ 6 ] and similar to our case, bowel perforation with subsequent surgery occurred in three patients and HSV was therefore detected with delay [ 5–7 ]. In three cases, HSV-2 was found [ 6 , 8 , 9 ]; in the remaining patients, the genotype was not characterized [ 3–5 , 7 ].…”

Protective role of flavonoids quercetin and silymarin in the viral-associated inflammatory bowel disease: an updated review

“…However, immunosuppression is associated with the Herpes simplex colitis or UC (Temtem et al 2021 ). CMV-associated colitis or UC has been linked to active illness, immunosuppressive medicine, steroid therapy, steroid-refractory disease progression and higher colectomy rates in IBD patients (with high-grade CMV infection) (Kjaer et al 2018 ; Mourad et al 2020 ; Hazır-Konya et al 2021 ; Leal et al 2022 ; Ouali and Achkar 2022 ). CMV has been also associated with early relapse of colitis.…”

Association Between Inflammatory Bowel Disease and Viral Infections

“…Because CMV is a common cause of refractory disease, individuals with acute severe steroid-refractory ulcerative colitis should be tested for the infection. Herpes simplex colitis is less prevalent in ulcerative colitis patients and is usually associated with immunosuppression [19]. In immunocompromised hosts, CMV colitis is an end-organ infectious consequence that is relatively frequent and hurts clinical outcomes.…”