Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn's colitis

Cottone, Mario; Pietrosi, Giada; Martorana, Giuseppe; Casà, Angelo; Pecoraro, G.; Oliva, L; Orlando, Ambrogio; Rosselli, Matteo; Rizzo, Aroldo; Pagliaro, Luigi

doi:10.1111/j.1572-0241.2001.03620.x

Cited by 251 publications

(116 citation statements)

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“…Previously, it was reported that CMV infection exacerbates UC refractory to IMT and the ratio of colectomy and mortality was high in UC patients concomitant with CMV infection [11,12,13]. In this study, 48.4% of UC patients refractory to IMT were diagnosed to be positive for CMV.…”

Section: Discussionmentioning

confidence: 65%

Effect and Safety of Granulocyte-Monocyte Adsorption Apheresis for Patients with Ulcerative Colitis Positive for Cytomegalovirus in Comparison with Immunosuppressants

et al. 2011

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Background: Cytomegalovirus (CMV) infection exacerbates ulcerative colitis (UC) refractory to immunosuppressive therapies (IMT). However, the underlying UC remained active in some UC patients, despite the fact that CMV-DNA in colonic mucosa became negative after antiviral therapy. Therefore, new therapeutic strategies for UC patients concomitant with CMV infection in mucosa are required. Aims: The aim of this study was to evaluate the effect and safety of granulocyte-monocyte adsorption apheresis (GMA) in UC patients positive for CMV infection after antiviral therapy. Methods: From October 2003 to December 2008, 64 patients with UC refractory to IMT, including steroids and immunomodulators, were enrolled in this retrospective, observational, multicenter study, which was reviewed and approved by the Institutional Review Board of Kyoto University. CMV infection was investigated by 3 methods (histologic examination, CMV antigenemia, and polymerase chain reaction). We investigated the clinical outcomes of GMA and IMT after 2 weeks of treatment with ganciclovir. Results: Thirty-one (48.4%) of 64 patients with UC refractory to IMT were positive for CMV. Of the 31 patients, 4 (12.9%) underwent colectomy. Twenty-seven patients (87.1%) underwent antiviral therapy. Of those 27 patients, 7 achieved remission following antiviral therapy alone. Of the remaining 20 patients who did not achieve remission despite the disappearance of CMV-DNA, 11 and 9 patients were treated with additional GMA (GMA group) and IMT (IMT group), respectively. Of 11 patients (GMA group), 9 achieved remission and 2 underwent colectomy. Out of the remaining 9 patients (IMT group), 4 achieved remission and 5 underwent colectomy. CMV-DNA was not detected in 11 patients after GMA, but it was detected again in all 5 patients of the IMT group who underwent colectomy. The total colectomy rate in UC patients positive for CMV was 35.5% (11/31). In addition, colectomy-free survival in the CMV relapse (+) group was estimated to be 12.9% at 65 months, while that in the CMV relapse (–) group was estimated to be 100% at 60 months. Conclusion: The colectomy ratio tends to be high in refractory UC patients with recurrent CMV reactivation or infection. Therefore, GMA might be a safe and effective treatment for UC patients positive for CMV because it does not induce CMV reactivation.

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Section: Discussionmentioning

confidence: 65%

Effect and Safety of Granulocyte-Monocyte Adsorption Apheresis for Patients with Ulcerative Colitis Positive for Cytomegalovirus in Comparison with Immunosuppressants

et al. 2011

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“…On the other hand, it has also been suggested that CMV infection of the gastrointestinal tract may be an early clue to the presence of immunological defects induced by an underlying neoplasia, 22 or may be associated with local immune degradation, as the prevalence of CMV enterocolitis is 4.6% in patients with ulcerative colitis and 0.8% in those with Crohn's disease. 23,24 However, neither neoplastic nor autoimmune disorders were present in our patient.…”

Section: Discussionmentioning

confidence: 82%

Cytomegalovirus cholangitis and pancreatitis in an immunocompetent patient

et al. 2005

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Cholangitis and pancreatitis associated with cytomegalovirus (CMV) infection in an immunocompetent patient is reported. Endoscopic retrograde cholangiography performed on a 55-year-old man for evaluation of the cause of jaundice and liver dysfunction revealed a distal focal irregular narrowing of the common bile duct. Microscopic findings of the resected specimen showed chronic cholangitis and CMV pancreatitis. Immunohistochemistry disclosed that epithelial cells in the inflamed bile duct were positive for CMV antigen, which was compatible with CMV cholangitis. Inflammation of the biliary tract or pancreas by CMV has been commonly reported as a complication in immunocompromised patients. Our report appears to be a rare case, but suggests that CMV cholangitis or pancreatitis should be considered in the differential diagnoses of common bile duct stenosis or pancreatitis even in immunocompetent individuals.

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“…Darüber hinaus ist es hilfreich zu berücksichtigen, dass die PMC in großen Serien zu Anfang des letzten Jahrhunderts vorwiegend unter dem Bild der fulminanten Sepsis verlief und nur zu 25-40% mit einer Diarrhö einherging. Auch bei Patienten mit chronisch entzündlichen Darmerkrankungen (CED), die auf eine Standardtherapie nicht ansprechen und einen komplizierten Verlauf zeigen, sollte eine C.-difficile-Infektion ( [48]; (ebenso wie eine CMV-Infektion [49,50]), ausgeschlossen werden.…”

Section: Die C-difficile-kolitis Sollte Auch Bei Patienten Auf Intenunclassified

Fehldiagnosen in der Gastroenterologie

Duchmann

Zeitz

2002

Internist

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Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn's colitis

Abstract: Cytomegalovirus infection is a frequent cause of severe refractory colitis. Rectal biopsy should always be performed in severe steroid-resistant colitis.

Cited by 251 publications

References 13 publications

Effect and Safety of Granulocyte-Monocyte Adsorption Apheresis for Patients with Ulcerative Colitis Positive for Cytomegalovirus in Comparison with Immunosuppressants

Effect and Safety of Granulocyte-Monocyte Adsorption Apheresis for Patients with Ulcerative Colitis Positive for Cytomegalovirus in Comparison with Immunosuppressants

Cytomegalovirus cholangitis and pancreatitis in an immunocompetent patient

Fehldiagnosen in der Gastroenterologie

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