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Cytomegalic colitis after total colectomy in ulcerative colitis: report of a case
M Shinozaki1, T Masaki, T Muto
1Department of Surgery, School of Medicine, the University of Tokyo, Japan.
Insights
Cytomegalovirus (CMV) colitis can cause severe rectal inflammation in ulcerative colitis patients after surgery. Early diagnosis and ganciclovir treatment are crucial for managing steroid-resistant symptoms.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Colorectal Surgery
Background:
- Ulcerative colitis (UC) patients undergoing total colectomy and ileorectal anastomosis are at risk for residual rectal inflammation.
- Postoperative management typically involves anti-inflammatory therapies, but refractory cases require further investigation.
Abstract:
A 58-year-old man with ulcerative colitis underwent total colectomy and ileorectal anastomosis. Steroid suppositories were administered postoperatively, and he had had no exacerbation in the residual rectum for 12 years. He suddenly presented with frequent bloody stools and anal pain. An intensive intravenous regimen of prednisolone was ineffective. Cytomegalic inclusion bodies were identified in biopsy specimens. Administration of ganciclovir reduced the ulcers remarkably. The clinical course suggested that this deterioration was caused by cytomegalovirus infection from the beginning. Cytomegalovirus colitis should be recognized as an exacerbating factor, even in ulcerative colitis patients who have undergone surgery, especially when the residual bowel inflammation is resistant to steroid therapy.