title: Cytomegalovirus infection in ulcerative colitis: a prospective, comparative study on prevalence and diagnostic strategy.
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.
authors.affiliation: Department of Gastroenterology, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Catalonia, Spain. edomenech.germanstrias@gencat.net
authors.forename: Eugeni
authors.initials: E
authors.lastname: Domènech
authors.forename: Roser
authors.initials: R
authors.lastname: Vega
authors.forename: Isabel
authors.initials: I
authors.lastname: Ojanguren
authors.forename: Agueda
authors.initials: A
authors.lastname: Hernández
authors.forename: Esther
authors.initials: E
authors.lastname: Garcia-Planella
authors.forename: Isabel
authors.initials: I
authors.lastname: Bernal
authors.forename: Mercè
authors.initials: M
authors.lastname: Rosinach
authors.forename: Jaume
authors.initials: J
authors.lastname: Boix
authors.forename: Eduard
authors.initials: E
authors.lastname: Cabré
authors.forename: Miquel A
authors.initials: MA
authors.lastname: Gassull
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000914:Antibodies, Viral / Q000097:blood; D016022:Case-Control Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology*; D015897:Comorbidity; D016572:Cyclosporine / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000453:epidemiology*; D003937:Diagnosis, Differential; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012720:Severity of Illness Index; D013256:Steroids / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D013256:Steroids; D016572:Cyclosporine