Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn's colitis.
OBJECTIVE
Cytomegalovirus infection has been reported as a cause of refractory inflammatory bowel disease, but no data are available on its prevalence in severe colitis. The aim of this study was to evaluate the prevalence and outcome of cytomegalovirus infection in a consecutive series of patients with severe steroid refractory colitis admitted to our department from 1997 to 1999.


METHODS
Among 62 patients with severe colitis, 55 with ulcerative colitis and seven with Crohn's disease, 19 (30%) were resistant to intravenous steroids and bowel rest. In all of them, rectal biopsies were examined for cytomegalovirus (the flexible proctoscopy being performed without air insufflation and limited to the first 10 cm). Buffy coat preparation on leukocytes was also performed to detect systemic infection. If cytomegalovirus was not detected, cyclosporine was started.


RESULTS
In seven (five with ulcerative colitis and two with Crohn's disease) out of 19 (36%) patients with refractory disease, cytomegalovirus was diagnosed in the rectal specimens as well as by buffy coat preparation. Five patients went into remission after antiviral treatment (three with ganciclovir and two with foscarnet). One patient did not respond and was operated on. In one patient, cytomegalovirus was found in the surgical specimen.


CONCLUSIONS
Cytomegalovirus infection is a frequent cause of severe refractory colitis. Rectal biopsy should always be performed in severe steroid-resistant colitis.
Clinica Medica R, Divisione di Medicina, Istituto di Medicina Generale e Pneumologia, Università degli studi di Palermo, Laboratorio di Microbiologia, Ospedale V Cervello, Italy.
M
M
Cottone
G
G
Pietrosi
G
G
Martorana
A
A
Casà
G
G
Pecoraro
L
L
Oliva
A
A
Orlando
M
M
Rosselli
A
A
Rizzo
L
L
Pagliaro
D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000821:virology*; D003424:Crohn Disease / Q000188:drug therapy / Q000821:virology*; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D004351:Drug Resistance; D006801:Humans; D007558:Italy; D007962:Leukocytes / Q000821:virology; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012007:Rectum / Q000473:pathology / Q000821:virology; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use
D000956:Antigens, Viral; D000998:Antiviral Agents; D013256:Steroids