title: Diffuse gastroduodenitis and enteritis associated with ulcerative colitis and concomitant cytomegalovirus reactivation after total colectomy: report of a case.
abstract: We report a rare case of peristomal pyoderma gangrenosum with severe gastroduodenal lesions, developing after total colectomy in a patient with ulcerative colitis and concomitant cytomegalovirus (CMV) enteritis. A 19-year-old man underwent total proctocolectomy with an ileal J-pouch anal anastomosis and diverting ileostomy, after 2 years of ineffective medical treatment. On postoperative day 6, severe peristomal pyoderma gangrenosum developed and progressed rapidly. Maintaining immunosuppressive therapy with corticosteroids for 6 days induced melena from the gastroduodenal lesions and enteritis with concomitant CMV reactivation. The patient required a jejunostomy, after the duodenal and intestinal CMV lesions had caused multiple perforations. Treatment with intensive cytapheresis was ineffective against the associated UC lesions, which healed with infliximab induction. The CMV reactivation was treated effectively with ganciclovir. The patient is being maintained on infliximab every 8 weeks and there has been no sign of recurrence of the gastroduodenitis-associated UC and CMV reactivation.
authors.affiliation: Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan. motoi.uchino@nifty.ne.jp
authors.forename: Motoi
authors.initials: M
authors.lastname: Uchino
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Bando
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsuoka
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirata
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takesue
authors.forename: Satoko
authors.initials: S
authors.lastname: Inoue
authors.forename: Naohiro
authors.initials: N
authors.lastname: Tomita
mesh_terms: D000914:Antibodies, Viral / Q000032:analysis; D001706:Biopsy; D003093:Colitis, Ulcerative / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D003587:Cytomegalovirus / Q000276:immunology* / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000821:virology; D003937:Diagnosis, Differential; D004382:Duodenitis / Q000175:diagnosis / Q000209:etiology*; D016099:Endoscopy, Gastrointestinal; D004751:Enteritis / Q000175:diagnosis / Q000209:etiology*; D005756:Gastritis / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D016737:Proctocolectomy, Restorative / Q000379:methods*; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral