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Cytomegalovirus infection in patients with inflammatory bowel disease
1Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Badalona, Catalonia, Spain.
Objective:
It has been suggested that, in inflammatory bowel disease, cytomegalovirus behaves in the intestine as a nonpathogenic bystander, and even its finding in intestinal mucosa has unclear clinical relevance. We report our experience with a small series of patients with refractory inflammatory bowel disease and cytomegalovirus infection and their clinical outcome.
Methods And Results:
Nine patients with moderate-severe attacks of inflammatory bowel disease did not respond to i.v. prednisone (1 mg/kg/day) for a mean of 24 days. Four of these patients were further treated with i.v. cyclosporine A (4 mg/kg/day). Cytomegalovirus infection was diagnosed in two patients after resection for treatment failure. In the remaining patients, cytomegalovirus infection was diagnosed in endoscopic mucosal biopsies and i.v. ganciclovir was then administered at a dose of 10 mg/kg/day for 2-3 wk. Five of these patients went into clinical remission, allowing corticosteroid and cyclosporine A discontinuation. Follow-up biopsies were performed and in all cases cytomegalovirus could not be detected in the colonic tissue. Two patients needed to be treated with intravenous cyclosporine A after antiviral therapy because of persistence of clinical symptoms despite the elimination of cytomegalovirus infection.
Conclusions:
Cytomegalovirus infection may play a role in the natural history of refractory inflammatory bowel disease and in some of its complications. The clearance of cytomegalovirus in colonic mucosa may lead some of these patients to remission.
Insights
Cytomegalovirus (CMV) infection may impact inflammatory bowel disease (IBD) severity. Treating CMV in refractory IBD patients with ganciclovir led to remission in some, suggesting a role for CMV clearance.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Cytomegalovirus (CMV) is often considered a bystander in inflammatory bowel disease (IBD).
- The clinical relevance of CMV detection in intestinal mucosa remains unclear.
- Refractory IBD cases present treatment challenges.
Purpose of the Study:
- To investigate the role of CMV infection in refractory IBD.
- To evaluate the clinical outcome of IBD patients with CMV infection treated with antiviral therapy.
Main Methods:
- Retrospective analysis of nine patients with moderate-severe IBD refractory to conventional treatment.
- Diagnosis of CMV infection via endoscopic biopsies or post-resection.
- Treatment with intravenous ganciclovir (10 mg/kg/day for 2-3 weeks).
Main Results:
- Five of seven patients treated with ganciclovir achieved clinical remission, allowing discontinuation of corticosteroids and cyclosporine A.
- CMV was undetectable in follow-up biopsies after ganciclovir treatment.
- Two patients required further treatment with cyclosporine A due to persistent symptoms despite CMV clearance.
Conclusions:
- CMV infection may significantly influence the course and complications of refractory IBD.
- Elimination of CMV from colonic mucosa can induce clinical remission in a subset of IBD patients.
- Antiviral therapy for CMV in refractory IBD warrants further investigation.