title: Cytomegalovirus positive ulcerative colitis: A single center experience and literature review.
abstract: OBJECTIVE
  To compare the clinical outcome of cytomegalovirus (CMV)-positive ulcerative colitis (UC) patients with and without antiviral therapy.
  
  
  METHODS
  This was a retrospective case-controlled study. The database of UC patients in our institution was scanned for documented presence of CMV on colonic biopsies. Demographics, clinical data, endoscopy findings and pathology reports were extracted from the patients' charts and electronic records. When available, the data from colonoscopies preceding and following the diagnosis of colonic CMV infection were also extracted. The primary outcomes of the study were colectomy/death during hospitalization and the secondary outcomes were colectomy/death through the course of the follow-up.
  
  
  RESULTS
  Thirteen patients were included in the study, 7 (53.5%) of them were treated with gancyclovir and 6 (46.5%) were not. Patients treated with antivirals presented with a more severe disease and 57% of them were treated with cyclosporine or infliximab before initiation of gancyclovir, while none of the patients without antivirals required rescue therapy. One patient died and another patient underwent urgent colectomy during hospitalization, both of them from the gancyclovir-treatment group. For the entire follow-up time (13 ± 13 mo), a total of 3 colectomies and one death occurred, all among the antiviral-treated patients (for colectomy: 3/7 vs 0/6 patients, P = 0.19; for combined adverse outcome: 4/7 vs 0/6 patients, P = 0.07). In 9/13 patients, immunohistochemistry for CMV was performed on biopsies obtained during a subsequent colonoscopy and was positive in one patient only.
  
  
  CONCLUSIONS
  Gancyclovir-treated patients had a more severe disease and outcome, probably unrelated to antiviral therapy. Immunohistochemistry-CMV-positive patients with mild disease may recover without antiviral therapy.
authors.affiliation: Uri Kopylov, Gila Sasson, Rami Eliakim, Shomron Ben-Horin, Department of Gastroenterology, Sheba Medical Center, Ramat Gan 52621, Israel.
authors.forename: Uri
authors.initials: U
authors.lastname: Kopylov
authors.forename: Gila
authors.initials: G
authors.lastname: Sasson
authors.forename: Bella
authors.initials: B
authors.lastname: Geyshis
authors.forename: Michal Tepperberg
authors.initials: MT
authors.lastname: Oikawa
authors.forename: Iris
authors.initials: I
authors.lastname: Barshack
authors.forename: Rami
authors.initials: R
authors.lastname: Eliakim
authors.forename: Shomron
authors.initials: S
authors.lastname: Ben-Horin
keywords: Cyclosporine; Cytomegalovirus; Gancyclovir; Immunohistochemistry; Ulcerative colitis