Effects of Antiviral Therapy for Patients With Inflammatory Bowel Disease and a Positive Intestinal Biopsy for Cytomegalovirus

Detection of Cytomegalovirus in Patients with Inflammatory Bowel Disease

“…Current guidelines from a number of societies recommend a flexible sigmoidoscopy with biopsies to rule out CMV in hospitalized patients with severe, medically refractory UC. 10,[14][15][16][17] Although this study supports these recommendations for patients with UC, a left-colonic examination is likely insufficient in patients with CD. Only a single patient with UC who had biopsies from the left and right colon from areas of inflammation was diagnosed with CMV disease exclusively from the right-colonic biopsies.…”

“…18,26 Serum-based tests including PCR and pp65 antigenemia have proven useful in transplant patients for determining when preemptive treatment should be initiated. 10,12,[28][29][30] In contrast, these noninvasive tests seem to be less useful for predicting tissue-invasive disease in patients with IBD. Our data demonstrate that only 31% of patients overall, including 50% with high-grade CMV, had evidence of systemic infection.…”

“…The pathology slides from patients with a diagnosis of CMV by IHC only were also reexamined to assess for missed viral cytopathic effects by H&E. The grade of CMV disease was determined for each patient according to the number of inclusion bodies from the biopsy with the greatest viral density as previously reported. 10 Low-grade disease was defined as 1 to 4 inclusions and high-grade disease as 5 or more inclusions. Two independent pathologists reviewed all pathology slides for the purpose of this study.…”

“…Patient demographics and disease characteristics have been reported previously. [3][4][5]8,10 Forty-three patients had low-grade CMV disease and 17 had high-grade CMV disease, defined as 5 or more CMV inclusions in the biopsy with the highest viral density. In the remaining 8 patients, the grade could not be determined.…”

“…[3][4][5] CMV is also associated, albeit less commonly, with severe Crohn's disease (CD), and rarely with pouchitis. [6][7][8][9] The importance of early detection has recently been suggested by Jones et al, 10 who demonstrated a reduction in colectomy rates in patients treated with antiviral therapy.…”