Cytomegalovirus infection in ulcerative colitis: A prospective, comparative study on prevalence and diagnostic strategy

Eugeni Domènech, Roser Vega, Isabel Ojanguren, Águeda Hernández, Esther Garcia-Planella, Isabel Bernal, Mercè Rosinach, Jaume Boix, Eduard Cabré, Miquel A. Gassull

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140 Citations (Scopus)

Abstract

Background: Cytomegalovirus (CMV) infection has been reported in ulcerative colitis (UC), especially in severe, steroid-refractory disease. However, its role in steroid-refractoriness remains unknown. Our goals were to evaluate the prevalence of CMV disease in UC, the best diagnostic strategy, and the influence of disease activity and/or treatment in its development. Methods: Prospective, observational study including 114 subjects with active UC requiring intravenous steroids, steroid-refractory UC, inactive UC on mesalamine, inactive UC on azathioprine, and healthy controls. CMV antibodies, pp65-antigenemia, and rectal biopsies for hematoxylin and eosin staining, immunohistochemistry, and CMV-pp67 mRNA were performed. These procedures were repeated after medical treatment only in patients with active UC. CMV disease was defined by the presence of inclusion bodies and/or positive immunohistochemistry in colonic biopsies. Results: CMV disease was found in 6 steroid-refractory, CMV-IgG-positive UC patients but not among controls, inactive UC, or steroid-responding UC patients. In 5 out of the 6 patients, CMV disease was diagnosed after 7-10 days on cyclosporine. Conclusions: CMV disease in UC only affects seropositive, steroid-refractory UC patients. Steroid/cyclosporine treatment together with disease activity may predispose to latent colonic CMV reactivation. The impact of antiviral therapy on the clinical outcome of these patients remains to be elucidated. Copyright © 2008 Crohn's & Colitis Foundation of America, Inc.
Original languageEnglish
Pages (from-to)1373-1379
JournalInflammatory Bowel Diseases
Volume14
Issue number10
DOIs
Publication statusPublished - 1 Dec 2008

Keywords

  • Antigenemia
  • Cytomegalovirus
  • Immunomodulators
  • Pp67 mRNA
  • Ulcerative colitis

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