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Utility of Reflex CMV Immunohistochemistry in Patients with Inflammatory Bowel Disease
Melek Buyuk1, Neslihan Berker1, Dogu Vuralli Bakkaloglu1
1Department of Pathology, Istanbul University Istanbul Faculty of Medicine, ISTANBUL, TÜRKİYE.
Insights
Cytomegalovirus (CMV) immunohistochemistry is valuable for diagnosing CMV infection in inflammatory bowel disease (IBD) patients, even without visible viral changes. This reflex test aids in timely diagnosis and management of IBD patients with CMV.
Area of Science:
- Gastroenterology
- Virology
- Pathology
Background:
- Cytomegalovirus (CMV) infection is a significant concern in patients with inflammatory bowel disease (IBD).
- Accurate and timely diagnosis of CMV infection is crucial for effective management of IBD flares.
- Traditional diagnostic methods may have limitations in detecting CMV in IBD biopsies.
Purpose of the Study:
- To investigate the association between CMV immunohistochemistry (IHC) positivity and clinical, endoscopic, and histologic findings in IBD patients.
- To evaluate the diagnostic utility of CMV IHC as a reflex test in routine histopathologic evaluation of IBD biopsies.
- To compare CMV IHC results with tissue CMV PCR findings.
Main Methods:
- Retrospective analysis of 191 IBD patients (ulcerative colitis and Crohn's disease) between 2018 and 2021.
- Analysis of clinical data, endoscopic scores, histologic activity (Simplified Geboes Score), cytopathic changes, CMV IHC, and tissue CMV PCR.
- Correlation of CMV IHC findings with other clinical and laboratory parameters.
Main Results:
- CMV IHC was positive in 32.4% of cases, significantly associated with ulcerative colitis, symptomatic presentation, extensive colonic involvement, high histologic activity, and ulceration.
- 74.2% of CMV IHC-positive cases lacked prior clinical suspicion for CMV infection.
- CMV IHC correlated significantly with tissue PCR (p < 0.001), with higher immunopositive cell counts in PCR-positive cases.
- Viral cytopathic changes were observed in only 30.6% of IHC-positive cases.
Conclusions:
- CMV immunohistochemistry is a valuable reflex test for pathologists evaluating IBD endoscopic biopsies, especially with severe histologic inflammation.
- This method can increase the detection of CMV infection, even when viral cytopathic effects are not apparent on H&E staining.
- CMV IHC can contribute to earlier diagnosis and appropriate management of CMV infection in IBD patients.
Objective:
We aimed to investigate the association between CMV immunohistochemistry positivity and clinical, endoscopic, histologic, and tissue CMV PCR findings in ileocolonoscopic biopsies of inflammatory bowel disease patients, and to assess the diagnostic value of CMV immunohistochemistry as a reflex test during routine histopathologic evaluation.
Material And Methods:
We conducted a retrospective analysis of 191 patients (136 ulcerative colitis, 55 Crohn`s disease) between 2018 and 2021. We analyzed clinical data, endoscopic Mayo scores, histologic activity (Simplified Geboes Score), cytopathic changes, CMV immunohistochemistry and tissue CMV PCR results.
Results:
CMV immunohistochemistry was positive in 32.4% of cases, significantly associated with ulcerative colitis (p=0.003), symptomatic presentation (p=0.001), extensive colonic involvement (p < 0.001), high histologic activity scores (p < 0.001), and ulceration (p < 0.001). Notably, 74.2% of CMV immunohistochemistry-positive cases had no preliminary clinical suspicion of CMV infection. Viral cytopathic changes were identified in only 30.6% of immunopositive cases on hematoxylin-eosin staining. CMV immunohistochemistry showed a significant correlation with tissue PCR (p < 0.001), although some discordant cases occurred. The PCR-positive group had significantly higher immunopositive cell counts compared to the PCR-negative group (p < 0.001). The number of biopsy fragments did not affect CMV detection by immunohistochemistry.
Conclusion:
While evaluating endoscopic biopsies of patients with inflammatory bowel disease, CMV immunohistochemistry assessment as a reflex test may be considered by the pathologist-even in the absence of identifiable viral cytopathic effects with hematoxylin-eosin- particularly when severe histologic inflammation is present. Although the clinical significance of CMV immunohistochemistry could not be fully determined in this study, this approach may increase the likelihood of detecting CMV infection and, in the appropriate clinical context, could contribute to timely diagnosis and management.
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