Prevalence and Diagnostic Challenges of Cytomegalovirus Colitis in Inflammatory Bowel Disease: A Retrospective Study...

Cytomegalovirus (CMV) colitis is a clinically significant complication in patients with inflammatory bowel disease (IBD), particularly in those with severe or steroid-refractory disease, where it may contribute to adverse outcomes. This study aimed to determine the frequency of acute CMV infection and tissue-confirmed CMV colitis among hospitalized IBD patients who underwent CMV evaluation.

We conducted a retrospective study including adult patients with IBD hospitalized between April 1, 2024, and December 31, 2024, at the Emergency Clinical County Hospital of Târgu Mureș, Romania. CMV serology (immunoglobulin G (IgG), immunoglobulin M (IgM)), colonoscopy with biopsy, and immunohistochemistry were performed when clinically indicated. Demographic characteristics, clinical presentation, treatment regimens, laboratory parameters, and histopathologic findings were analyzed for all included patients.

54 IBD patients were evaluated. The mean age was 41 years, and most were male. Crohn's disease was diagnosed in 24 patients (44.44%) and ulcerative colitis in 30 patients (55.56%). Three patients (5.55%) showed evidence of acute CMV infection based on serology. Only one patient (1.85%) was diagnosed with CMV colitis by immunohistochemistry. All patients with evidence of CMV infection had received corticosteroid therapy, although the small number of cases limits interpretation.

CMV colitis was uncommon in this cohort of evaluated patients. Diagnosis primarily relied on histopathologic confirmation, with serology serving only as a limited adjunct. CMV infection should be considered in patients with active or steroid-refractory disease. Observations regarding corticosteroid exposure should be interpreted cautiously and considered hypothesis-generating.