title: Disseminated cytomegalovirus infection in Crohn's disease following anti-tumour necrosis factor therapy.
abstract: This case report describes a 63-year-old woman with a 15-year history of Crohn's disease. After a severe relapse with colitis she was treated with immunosuppressive agents, including an increased dosage of corticosteroids, azathioprine and a single dose of infliximab (anti-tumour necrosis factor-alpha). This led to a brief improvement, which was followed by worsening diarrhoea, fever and skin lesions. Biopsies from upper and lower endoscopies and from an ulcerative skin lesion revealed cytomegalovirus vasculitis in all the tissues removed. The patient improved slowly by withdrawal of the immunosuppressives and with anti-viral therapy. Whenever patients with inflammatory bowel disease deteriorate rapidly, cytomegalovirus infection should be ruled out before the immunosuppressive therapy is fortified.
authors.affiliation: Department of Internal Medicine, Kantonsspital Münsterlingen, Scherzingen, Switzerland. daniel.helbling@dk5.unibe.ch
authors.forename: Daniel
authors.initials: D
authors.lastname: Helbling
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Breitbach
authors.forename: Martin
authors.initials: M
authors.lastname: Krause
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D003424:Crohn Disease / Q000188:drug therapy* / Q000821:virology; D003586:Cytomegalovirus Infections / Q000150:complications*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D000069285:Infliximab; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications*; D017193:Skin Diseases, Viral / Q000150:complications*; D014657:Vasculitis / Q000821:virology
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D000069285:Infliximab