一个患有重症治疗耐药性性结肠炎的患者的细胞巨乳病毒结肠炎
Michelle M Bao1, Juliana M Kennedy1, Michael T Dolinger1
1Division of Pediatric Gastroenterology, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, NY, USA.
Crohn's & colitis 360
|March 6, 2024
概括
细胞巨乳病毒 (CMV) 大肠炎可能发生在性结肠炎 (UC) 患者中,即使是那些接受高级治疗方法 (如upadacitinib) 的患者. 在UC患者中,对CMV的及时评估至关重要,UC患者的症状恶化不响应治疗.
科学领域:
- 胃肠病学 胃肠病学
- 传染性疾病 传染性疾病
- 免疫学 免疫学 免疫学
背景情况:
- 在性结肠炎 (UC) 中已知有细胞巨乳病毒 (CMV) 反激活,但其在疾病进展中的确切作用尚不清楚.
- 在UC中CMV重新激活的危险因素包括疾病严重程度和免疫抑制疗法,如皮质类固醇和免疫调节剂.
研究的目的:
- 在患有耐火性性结肠炎的儿科患者中报告细胞巨乳病毒结肠炎的病例.
- 在UC的背景下讨论upadacitinib在CMV再激活中的潜在作用.
主要方法:
- 一个13岁的男性患有UC不耐多次治疗的病例报告.
- 细胞巨乳病毒结肠炎的诊断通过灵活的西格莫显微镜活检得到证实.
- 治疗包括静脉注射甘西克洛维尔和免疫抑制逐渐减少,随后进行手术干预.
主要成果:
- 患者经历了症状恶化,尽管升级了上达西替尼和普雷迪尼松治疗.
- 被诊断出细胞巨乳病毒结肠炎,并用甘西克洛维尔治疗.
- 尽管最初有反应,但患者最终需要进行亚总结肠切除术和恢复性直结肠切除术.
结论:
- 乌帕达西替尼 (Upadacitinib) 是一种 Janus 激酶抑制剂,由于其对疹病毒的影响,可能会导致 CMV 重活化.
- 在所有呈现急性症状恶化症状的性结肠炎患者中,应考虑CMV结肠炎,特别是当该患者对当前疗法耐药时.
- 在UC患者中,对CMV的诊断评估是必不可少的,UC患者的症状恶化并且对增加的免疫抑制缺乏反应.
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