Cytomegalovirus Colitis in Immunocompetent and Immunocompromised Children

Abstract

Background: Data about cytomegalovirus (CMV) colitis in children are scarce. We aimed to describe the characteristics of childhood CMV colitis in terms of risk factors, clinical symptoms, diagnosis, therapeutic approaches, and outcomes. Methods: Inflammatory bowel disease (IBD) and non-IBD patients with CMV colitis diagnosed by histology and tissue CMV PCR at 2 tertiary centers between January 2017 and November 2019 were studied. Clinical and laboratory data were retrieved from medical records. Underlying conditions, immune status, response to therapy and outcomes were described and followed up to 6 months after diagnosis. Results: A total of 16 children (8 non-IBD, 7 ulcerative colitis and 1 Crohn's disease) with CMV colitis were included. All patients had persistent diarrhea (bloody in 13 cases). There was a significant age difference between IBD and non-IBD children (P < 0.05). The final diagnosis in 1 patient was immunodeficiency with a mutation in JAK1 gene. Three children were categorized as apparently immunocompromised and 4 children as apparently immunocompetent. Ulcer was not visible in 2 children from the non-IBD group. The mean fecal calprotectin level of IBD children was significantly higher than that of non-IBD children (376.12 ± 231.21 µg/g vs. 160.96 ± 69.94 µg/g, P < 0.05). After follow-up, 1 patient died because of another reason. Ganciclovir was used in 14 of 16 children for 3 weeks and the treatment was continued with valganciclovir in selected 6 children. Conclusions: CMV colitis is a rare but overlooked cause of prolonged diarrhea in immunocompetent and immunocompromised children. CMV colitis might present without any ulcer formation at colonoscopy in infants.

Routine Histology-Based Diagnosis of CMV Colitis Was Rare in Pediatric Patients

“…The incidence of CMV colitis in pediatric IBD patients is not well-established. It more frequently affects patients with UC than Crohn's disease (CD) (9), even in children (3). IBD patients, both children (10) and adults (9), with CMV colitis, have been found more commonly to be steroid-refractory, leading to increased complications (11).…”

“…CMV colitis in pediatric patients with inflammatory bowel disease (IBD) can present similar to a non‐infectious flare‐up (2). It has also been found as a rare cause of colitis in immunocompetent infants (3).…”