Resolution of CMV Infection in the Bowel on Vedolizumab Therapy

Rawa-Gołębiewska, Anna; Lenarcik, Małgorzata; Zagórowicz, Edyta

doi:10.1093/ecco-jcc/jjz033

Cited by 13 publications

(6 citation statements)

References 5 publications

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“…Concerning vedolizumab, a new immunosuppressive drug that targets the homing of α4β7 lymphocytes, a risk of severe CMV infection has been suggested in the context of either primary infection [ 115 ] or reactivation [ 116 , 117 ]. Other studies are needed to confirm these preliminary observations.…”

Section: Inflammation and Immunosuppressive Therapies Contribute Tmentioning

confidence: 99%

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

et al. 2020

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Cytomegalovirus (CMV) infects approximately 40% of adults in France and persists lifelong as a latent agent in different organs, including gut. A close relationship is observed between inflammation that favors viral expression and viral replication that exacerbates inflammation. In this context, CMV colitis may impact the prognosis of patients suffering from inflammatory bowel diseases (IBDs), and notably those with ulcerative colitis (UC). In UC, the mucosal inflammation and T helper cell (TH) 2 cytokines, together with immunomodulatory drugs used for controlling flare-ups, favor viral reactivation within the gut, which, in turn, increases mucosal inflammation, impairs corticoid and immunosuppressor efficacy (the probability of steroid resistance is multiplied by more than 20 in the case of CMV colitis), and enhances the risk for colectomy. This review emphasizes the virological tools that are recommended for exploring CMV colitis during inflammatory bowel diseases (IBD) and underlines the interest of using ganciclovir for treating flare-ups associated to CMV colitis in UC patients.

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Section: Inflammation and Immunosuppressive Therapies Contribute Tmentioning

confidence: 99%

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

et al. 2020

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“…This indicated that well-known factors other than vedolizumab were driving the CMV infection. Going a step further, one study did suggest that vedolizumab was in fact effective in treating CMV colitis in UC [ 12 ]. Our patient, despite being on vedolizumab monotherapy without any other systemic immunosuppressant therapy, developed CMV colitis.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Colitis in a Patient With Ulcerative Colitis on Vedolizumab Monotherapy

Meeralam¹,

Qurashi²,

Masoudi³

et al. 2023

Cureus

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Cytomegalovirus (CMV) is a human herpes-type virus with variable clinical manifestations. Infections in immunocompetent patients are usually asymptomatic or mild, and severe infections are generally seen in immunosuppressed individuals. CMV colitis is not uncommon in patients with ulcerative colitis (UC) and is mostly associated with the use of steroids, immunomodulators like azathioprine, and biologics like infliximab, which have systemic immunosuppressive effects. Vedolizumab is an anti-integrin antibody that is gut-selective without any systemic effects. We report an unusual presentation of a female patient with UC who had concomitant CMV colitis and erythema nodosum, who was on vedolizumab, and not on any steroids or other immunosuppressants. She responded well to anti-viral treatment and steroids.

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“…In one patient [ 12 ], the details regarding opportunistic infections were unavailable. One of the remaining two patients had active UC and CMV infection and recovered after VDZ treatment without the need for antiviral therapy, although CMV infection was detected after VDZ administration [ 14 ]. The other case was of a patient with UC and primary CMV infection who was receiving VDZ and azathioprine before primary CMV infection.…”

Section: Discussionmentioning

confidence: 99%

Ulcerative colitis successfully treated with vedolizumab in the presence of comorbid opportunistic infections: a case report

et al. 2023

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Background Opportunistic infections associated with immunosuppressive treatments for inflammatory bowel disease pose an important safety concern. Here we report the case of a patient with active ulcerative colitis and cryptococcal pneumonia who was treated with vedolizumab combined with fluconazole. Case presentation A 56-year-old Japanese man with ulcerative colitis and a history of Sweet’s syndrome who was taking prednisolone and azathioprine presented with a moderate exacerbation of ulcerative colitis, abdominal pain, diarrhea, and bloody stools along with cytomegalovirus infection. Increasing the prednisolone dose without using antiviral drugs improved cytomegalovirus infection; however, ulcerative colitis did not improve, and cryptococcal pneumonia occurred. Thus, treatment with fluconazole followed by vedolizumab was initiated for ulcerative colitis. The patient gradually recovered and achieved clinical remission without the exacerbation of pneumonia. Conclusions We reported the first case of a patient with ulcerative colitis who was treated with vedolizumab and concomitant fluconazole for active cryptococcal pneumonia. Vedolizumab constitutes a high-potential treatment regimen owing to its safety in inflammatory bowel disease associated with opportunistic infections.

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Resolution of CMV Infection in the Bowel on Vedolizumab Therapy

Cited by 13 publications

References 5 publications

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

Cytomegalovirus and Inflammatory Bowel Diseases (IBD) with a Special Focus on the Link with Ulcerative Colitis (UC)

Cytomegalovirus Colitis in a Patient With Ulcerative Colitis on Vedolizumab Monotherapy

Ulcerative colitis successfully treated with vedolizumab in the presence of comorbid opportunistic infections: a case report

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