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Ulcerative colitis: a case of steroid refractory disease
Lennard Lee1, Mohammed Majid Akhtar, Anjum Gardezisanjliajk
1Milton Keynes NHS Foundation Trust, Milton Keynes, UK.
BMJ Case Reports
|May 2, 2013
Summary
Cytomegalovirus (CMV) infection can mimic steroid-refractory ulcerative colitis. Prompt antiviral treatment with valganciclovir led to rapid recovery in a patient with severe symptoms, highlighting CMV as a critical differential diagnosis.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Immunology
Background:
- Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) requiring long-term management.
- Steroid-refractory disease presents a significant challenge in UC treatment, necessitating exploration of alternative diagnoses and therapies.
Observation:
- A 21-year-old female with a history of UC presented with an 8-week history of severe bloody diarrhea, abdominal pain, and weight loss.
- Despite treatment with intravenous steroids, topical therapy, and anti-tumour necrosis factor (TNF) therapy, her symptoms persisted, indicating steroid-refractory disease.
Findings:
- Flexible sigmoidoscopy with histology revealed cytomegalovirus (CMV)-associated colitis.
- Initiation of intravenous antiviral therapy (valganciclovir) resulted in a rapid and complete symptom resolution.
Implications:
- CMV infection should be considered in the differential diagnosis of steroid-refractory ulcerative colitis, particularly in immunocompromised patients or those with severe, unresponsive disease.
- Early identification and targeted antiviral treatment of CMV colitis can prevent disease progression and improve patient outcomes, avoiding unnecessary escalation of immunosuppressive therapies.
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