Primary Infection with Cytomegalovirus in Ulcerative Colitis

Martin, Stanley I.; Sepehr, Alireza; Fishman, Jay A.

doi:10.1007/s10620-006-9474-9

Dig Dis Sci

2006

DOI: 10.1007/s10620-006-9474-9

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Primary Infection with Cytomegalovirus in Ulcerative Colitis

Stanley I. Martin

Alireza Sepehr

Jay A. Fishman

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Cited by 5 publications

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“…Ó Springer Science+Business Media, LLC 2007 I read with interest the case report by Martin et al [1] in a recent issue of this journal. I agree that a subgroup of patients with inflammatory bowel disease and concomitant CMV colitis do benefit from antiviral treatment.…”

mentioning

confidence: 99%

Distinguishing Primary CMV Infection from Reactivation of Latent Infection

Subramanian

2007

Dig Dis Sci

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mentioning

confidence: 99%

Distinguishing Primary CMV Infection from Reactivation of Latent Infection

Subramanian

2007

Dig Dis Sci

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Inflammatory and Infectious Syndromes Associated With Cancer Immunotherapies

Fishman

Hogan

Maus

2018

Clinical Infectious Diseases

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Immunotherapy using antibodies to immune checkpoint molecules or targeted chimeric antigen receptor-modified T cells (CAR-T cells) represent dramatic advances in cancer treatment. These therapies mediate immune-related adverse events that may mimic or amplify infectious presentations. Checkpoint inhibitor therapy may be associated with diverse irAEs including mild skin, endocrine, and autoimmune manifestations or severe inflammatory processes including colitis, pneumonitis, myocarditis, and shock. CAR-T-cell therapies may induce toxicities including cytokine-release syndrome with fevers and multiorgan dysfunction, CAR-T-cell–related encephalopathy syndrome with altered mental status and neurologic dysfunction, or hemophagocytic lymphohistiocytosis-macrophage-activation syndrome. Infectious risks may relate to prior cancer therapies or to treatments of inflammatory dysregulation, including corticosteroids and inhibitors of tumor necrosis factor-α and interleukin-6. Immune activation may unmask subclinical infections. Clinical approaches must attempt to identify infections in the face of immunotherapy-associated inflammatory processes. Empirical antimicrobial therapies should not be delayed based on the presumption of noninfectious syndromes.

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Cytomegalovirus enterocolitis with subsequent diagnosis of coexisting new-onset inflammatory bowel disease

Luangsirithanya¹,

Treewaree²,

Pongpaibul

et al. 2021

Medicine

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Introduction: Gastrointestinal (GI) cytomegalovirus (CMV) infection coexisting with or followed by a diagnosis of inflammatory bowel disease (IBD) is infrequently reported. Not recognizing this condition may delay IBD diagnosis in patients with GI-CMV disease who do not or partially respond to antiviral agents, which could consequently result in unsatisfied treatment outcomes. Patient concerns: Two immunocompetent patients with no known underlying GI conditions presented with acute bloody diarrhea. The first patient developed diarrhea and hematochezia after admission to intensive care unit (ICU) because of severe alcoholic pancreatitis for 10 days duration. Computed tomography abdomen showed segmental jejunal thickening. The other patient presented with a 1-week history of severe bloody diarrhea which required ICU admission. Colonoscopy showed multiple ulcers along terminal ileum and colon. Diagnosis: These 2 patients were initially diagnosed with CMV jejunitis and ileocolitis, respectively, based on endoscopic and histopathologic findings. Both had partial response to treatment with 3 weeks of intravenous ganciclovir. Crohn disease was suspected because of persistent ulcerations on the follow-up endoscopy with the presence of pathological features of chronic inflammation and disappearance of previously detected CMV-infected cells. Intervention: Both patients were treated with systemic corticosteroids and azathioprine. Outcomes: Both patients had complete clinical improvement. Prednisolone could be tapered off in 6 months. Follow-up video capsule endoscopy (VCE) at 6 months showed improvement of mucosal inflammation and ulcers, but neither were completely healed in the first patient. Follow-up colonoscopy at 6 months showed complete resolution of ulcers and inflammation in the second patient. Lessons: IBD should be suspected in patients with a diagnosis of GI-CMV disease who are immunocompetent and have a partial response to antiviral agents. This clinical scenario could be caused by either CMV infection activating immune response resulting in IBD onset, or CMV infection superimposed on pre-existing latent IBD.

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Primary Infection with Cytomegalovirus in Ulcerative Colitis

Cited by 5 publications

References 35 publications

Distinguishing Primary CMV Infection from Reactivation of Latent Infection

Distinguishing Primary CMV Infection from Reactivation of Latent Infection

Inflammatory and Infectious Syndromes Associated With Cancer Immunotherapies

Cytomegalovirus enterocolitis with subsequent diagnosis of coexisting new-onset inflammatory bowel disease

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