title: Cytomegalovirus infection in severe ulcerative colitis patients undergoing continuous intravenous cyclosporine treatment in Japan.
abstract: OBJECTIVE
  To investigate active cytomegalovirus (CMV) infection following the cyclosporine A (CyA) treatment of steroid-refractory ulcerative colitis (UC).
  
  
  METHODS
  Twenty-three patients with severe UC not responding to steroid therapy (male 14, and female 9) enrolled at Nagoya University Hospital from 1999 to 2005. They received continuous intravenous infusion of CyA (average 4 mg/kg per day) for 1 mo. Serum and colonic biopsy samples were collected before CyA treatment and 4 d, 10 d, 20 d, and 30 d after treatment. Patients were evaluated for CMV by using serology (IgM antibody by ELISA), quantitative real-time PCR for CMV DNA, and histopathological assessment of hematoxylin and eosin (HE)-stained colonic biopsies. CMV infection was indicated by positive results in any test.
  
  
  RESULTS
  No patients had active CMV infection before CyA treatment. Eighteen of 23 UC patients treated with CyA were infected with active CMV (IgM antibody in 16/23 patients, 69.6%; CMV DNA in 18/23 patients, 78.2%; and inclusion bodies in 4/23 patients, 17.3%). There was no difference in the active CMV-infection rate between males and females. Active CMV infection was observed after approximately 8 d of CyA treatment, leading to an exacerbation of colitis. Fifteen of these 18 patients with active CMV infection (83.3%) required surgical treatment because of severe deteriorating colitis. Treatment with ganciclovir rendered surgery avoidable in three patients.
  
  
  CONCLUSIONS
  Our results suggest that active CMV infection in severe UC patients treated with CyA is associated with poor outcome. Further, ganciclovir is useful for treatment of CMV-associated UC after immuno-suppressive therapy.
authors.affiliation: Department of Gastroenterology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. myminami@med.nagoya-u.ac.jp
authors.forename: Masaaki
authors.initials: M
authors.lastname: Minami
authors.forename: Michio
authors.initials: M
authors.lastname: Ohta
authors.forename: Teruko
authors.initials: T
authors.lastname: Ohkura
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ando
authors.forename: Naoki
authors.initials: N
authors.lastname: Ohmiya
authors.forename: Yasumasa
authors.initials: Y
authors.lastname: Niwa
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
mesh_terms: D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage; D003093:Colitis, Ulcerative / Q000150:complications* / Q000188:drug therapy*; D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects*; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy; D005260:Female; D015774:Ganciclovir / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D007275:Injections, Intravenous; D007564:Japan; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D015774:Ganciclovir