Systemic cytomegalovirus infection complicating ulcerative colitis: a case report and review of the literature

Abstract

Cytomegalovirus is a common infection worldwide and in the immunocompromised individual it can be a major cause of morbidity and mortality. In patients with inflammatory bowel disease cytomegalovirus infection has been described in both immunocompetent and immunocompromised individuals. A 34 year old man with an exacerbation of his colitis was diagnosed as having both cytomegalovirus colitis and hepatitis. The diagnosis was made on the classical appearance of “owl’s eye” inclusion bodies on colonic and hepatic biopsies and, in addition, viral serology and polymerase chain reaction (PCR) analysis of the cytomegalovirus DNA copy number. Fourteen days of treatment with ganciclovir led to a prompt improvement in the symptoms of colitis, resolution of the pyrexia, normalisation of the liver function tests, and clearance of the virus, as measured by a negative cytomegalovirus DNA PCR. Cytomegalovirus infection is a potentially fatal complication of treatment induced immunosuppression in patients with inflammatory bowel disease. As in this case, infection may be systemic and not confined to the intestine. Prompt diagnosis using histology, serology, and PCR analysis allows prompt introduction of therapy and an improved prognosis.

Acute Cytomegalovirus Infection Is a Risk Factor in Refractory and Complicated Inflammatory Bowel Disease

“…Moreover, inflammation itself seems to be a predisposing factor because of the demonstrated tropism of CMV for proliferating cells of granulation tissues [1]. In recent years, cases of inflammatory bowel disease (IBD) associated with CMV infection have occasionally been reported [18][19][20].…”

Fatal cytomegalovirus infection with CD4+ T-lymphocytopenia durincg corticosteroid therapy for bronchial asthma

“…lymphocytopenia. Disseminated CMV infection is common in patients with AIDS or organ transplantation [1], and has been reported in patients with immunosuppressive agents [2][3][4]. However, disseminated CMV infection with use of corticosteroid without pulsed methylprednisolone or other immunosuppressive agents is rare [4][5][6][7].…”

Primary Infection with Cytomegalovirus in Ulcerative Colitis

“…The patient who died was the oldest in the group, with the diagnosis of CMV colitis made after surgery for toxic megacolon [19]. A second patient who required surgery was treated with intravenous acyclovir instead of ganciclovir, a drug with less anti-CMV activity [12]. CMV is associated with infection of the colon in individuals with immunodeficiency, such as AIDS, organ transplantation, and malignancy with chemotherapy [1].…”

“…Cases included in the analysis included patients with underlying UC (biopsyproven) and probable primary CMV documented by a positive CMV IgM and IgG serology [6,[9][10][11][12][13][14][15][16][17][18][19][20]. The results are presented in Table 1.…”