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Primary cytomegalovirus infectious colitis complicating Crohn's disease successfully treated with oral valganciclovir

Venkataraman Subramanian1, Caroline Finlayson, Thomas Harrison

  • 1Department of Gastroenterology, St George's Healthcare NHS Trust, Blackshaw Road, London SW17 0QT, United Kingdom. venkat@nottingham.ac.uk

Journal of Crohn'S & Colitis
|December 3, 2010
PubMed

Insights

Primary cytomegalovirus (CMV) colitis is rare in adults with inflammatory bowel disease (IBD). This case highlights a young woman with Crohn's colitis who experienced a primary CMV infection, successfully treated with antiviral therapy.

Area of Science:

  • Gastroenterology
  • Virology
  • Immunology

Background:

  • Cytomegalovirus (CMV) colitis in inflammatory bowel disease (IBD) patients typically results from viral reactivation.
  • Primary CMV infections are uncommon in adult IBD patients, and immunosuppressive therapy increases infection risk.

Observation:

  • A 26-year-old female with underlying Crohn's colitis presented with symptoms suggestive of a primary CMV infection.
  • Diagnostic findings included a positive CMV IgM titer, low-avidity IgG antibodies, high plasma CMV DNA levels, and immunohistological confirmation of CMV in the colon.

Findings:

  • The patient received intravenous ganciclovir, leading to a decrease in plasma CMV DNA.
  • Oral valganciclovir was administered for completion, resulting in undetectable plasma CMV DNA levels.

Implications:

  • This case underscores the possibility of primary CMV colitis in adult IBD patients, even without a history of reactivation.
  • Early diagnosis and prompt antiviral treatment are crucial for managing primary CMV colitis in IBD.
  • Further research may elucidate risk factors and optimal management strategies for primary CMV infections in this population.

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