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Pouchitis associated with primary cytomegalovirus infection
D Moonka1, E E Furth, R P MacDermott
1Department of Medicine, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia 19104-4283, USA.
The American Journal of Gastroenterology
|February 19, 1998
Summary
Cytomegalovirus (CMV) infection can cause refractory pouchitis in patients with ulcerative colitis after surgery. Prompt ganciclovir treatment led to remission, highlighting CMV as a key differential diagnosis.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Surgical Pathology
Background:
- Ulcerative colitis patients undergoing total proctocolectomy with ileoanal J-pouch formation are susceptible to pouchitis.
- Refractory pouchitis necessitates exploring diverse etiologies beyond typical bacterial or autoimmune causes.
Observation:
- A patient presented with severe, treatment-resistant pouchitis.
- Bloodwork revealed atypical lymphocytosis and serology indicative of primary cytomegalovirus (CMV) infection.
- Pouch biopsies confirmed CMV infection with characteristic inclusion bodies and positive cultures.
Findings:
- Primary CMV infection was identified as the cause of refractory pouchitis.
- A 10-day course of ganciclovir resulted in clinical improvement and resolution of pouchitis.
- The patient maintained remission for over five years post-treatment.
Implications:
- Cytomegalovirus infection should be considered in the differential diagnosis of pouchitis, even in immunocompetent hosts.
- The ileoanal J-pouch can serve as a site for primary CMV infection, analogous to the colon.
- This case underscores the importance of diagnostic vigilance for opportunistic infections in post-surgical gastrointestinal conditions.