Papaverine adjuvant therapy for microcirculatory disturbance in severe ulcerative colitis complicated with CMV infection: a case report

Abstract

Ulcerative colitis has hypercoagulable state and high risk of thrombosis; so mucosal disturbance of microcirculation may be mediate and amplify the inflammation of ulcerative colitis. A 56-year-old female patient was admitted in hospital for discontinuously mucous bloody stool for more than 1 year. Ulcerative colitis was determined after colonoscopy and pathologic examination. Mesalazine was effective during the year, but her symptoms recurred three times due to her bad compliance. One month before admission, the patient had severe recurrence after mesalazine withdrawal. At this time, the result of quantitative fluorescence PCR of colonic histic CMV-DNA was 1.6 × 104 copies/mL positive, CMV colitis was accompanied. After 4 weeks of ganciclovir and 6 weeks of mesalazine usage and nutrition support, the symptoms of diarrhea and abdominal cramp did not improve; stool frequency was more than twenty times a day. Probe-based confocal laser endomicroscopy revealed local microcirculation disturbance. Papaverine 90-mg slow drip for at least 10 h a day was added. The symptoms dramatically disappeared after 3 days of papaverine treatment. The patient had yellow mushy stool 2–3 times a day. Pathological findings showed diffuse submucosal hemorrhage and transparent thrombosis in capillaries. Treatment of microcirculatory disturbance in severe UC is a promising adjuvant therapy. Confocal laser endomicroscopy may be an effective method for microcirculation judgment.

Reduced Intravenous Fluorescein Dose for Upper and Lower Gastrointestinal Tract Probe-Based Confocal Laser Endomicroscopy

“…Recent investigations have demonstrated that fluorescein leakage reflects microcirculatory disturbances and is considered to be an important finding to identify malignant lesions or inflammatory mucosa of ulcerative colitis. [25][26][27] The present study has several limitations. Firstly, this is a pilot study and it is difficult to draw a solid conclusion; nevertheless, it highlights the potential dose reduction of IV fluorescein during pCLE.…”

“…In addition to the attempt to reduce the dose of IV fluorescein, a local application of fluorescent dye may become a solution for patients who have a severe allergy to fluorescein; however, the standard clinical use remains IV administration as fluorescein leakage from abnormal vessels cannot be identified with local fluorescein alone. Recent investigations have demonstrated that fluorescein leakage reflects microcirculatory disturbances and is considered to be an important finding to identify malignant lesions or inflammatory mucosa of ulcerative colitis [ 25 - 27 ].…”

Analysis of the Efficacy and Pharmacological Mechanisms of Action of Zhenren Yangzang Decoction on Ulcerative Colitis Using Meta-Analysis and Network Pharmacology

“…Prostaglandin synthetase activity in rectal biopsy specimens from patients with UC has been shown to fall on treatment with sulfasalazine, local steroids, and codeine phosphate [ 47 ]. Papaverine adjuvant can treat microcirculatory disturbance in severe UC complicated with cytomegalovirus infection [ 48 ]. These studies reveal an effect on the regulation of inflammation and immune function.…”

The effect of papaverine on tendon healing and adhesion in rats following Achilles tendon repair

“…Papaverine, an opioid analog possessing myorelaxant and vasodilator effects on vascular smooth muscles, finds application in treating ischemia caused by spasms in the heart, brain, and peripheral blood vessels. [ 8 ] While a study reported that the aerosol form of papaverine accelerates wound healing and stimulates pluripotent CD34 cells,[ 9 ] another study demonstrated its application in a cream form on seven skin flaps, resulting in increased flap survival. [ 10 ] However, no prior research has explored the influence of papaverine on tendon healing.…”