Cytomegalovirus Colitis in a Patient with Severe Treatment Refractory Ulcerative Colitis

Area of Science:

• Gastroenterology
• Infectious Diseases
• Immunology

Background:

• Cytomegalovirus (CMV) reactivation is known in ulcerative colitis (UC), but its precise role in disease progression remains unclear.
• Risk factors for CMV reactivation in UC include disease severity and immunosuppressive therapies such as corticosteroids and immunomodulators.

Purpose of the Study:

• To report a case of cytomegalovirus colitis in a pediatric patient with refractory ulcerative colitis.
• To discuss the potential role of upadacitinib in CMV reactivation within the context of UC.

Main Methods:

• Case report of a 13-year-old male with UC refractory to multiple treatments.
• Diagnosis of cytomegalovirus colitis confirmed via flexible sigmoidoscopy biopsy.
• Treatment involved intravenous ganciclovir and immunosuppression tapering, followed by surgical intervention.

Main Results:

• The patient experienced worsening symptoms despite escalating upadacitinib and prednisone therapy.
• Cytomegalovirus colitis was diagnosed and treated with ganciclovir.
• Despite initial response, the patient ultimately required subtotal colectomy and restorative proctocolectomy.

Conclusions:

• Upadacitinib, a Janus kinase inhibitor, may potentially contribute to CMV reactivation due to its effects on herpesviruses.
• CMV colitis should be considered in all ulcerative colitis patients presenting with acute symptom exacerbation, especially when refractory to current therapies.
• Diagnostic evaluation for CMV is essential in UC patients with worsening symptoms and lack of response to increased immunosuppression.