title: Cytomegalovirus infection of the ileoanal pouch: clinical characteristics and outcomes.
abstract: BACKGROUND
  Up to 30% of cases of pouchitis are felt to have a secondary cause. Cytomegalovirus (CMV) may represent a possible etiopathological agent. Here, we report our experience with CMV involvement of the pouch, including risk factors, clinical features, and pouch outcomes in patients with inflammatory bowel disease after proctocolectomy with ileal pouch-anal anastomosis.
  
  
  METHODS
  The pathology database at Mayo Clinic in Rochester was searched between January 1995 and October 2012 for patients with a tissue diagnosis of CMV of the pouch following ileal pouch-anal anastomosis.
  
  
  RESULTS
  Seven patients with CMV inclusions of the pouch were identified. The median age was 35 (range, 10-53) years, and the majority were female (71%). Five patients (71%) were on immunosuppressive medications including 4 who had undergone orthotopic liver transplantation for primary sclerosing cholangitis. The clinical presentation was similar among all patients: the majority had diarrhea (86%), fever (71%), and abdominal pain (57%). All had mucosal inflammation, with 71% having focal ulcerations in the pouch and 60% having inflammatory changes in the prepouch ileum. All patients improved with ganciclovir. None required pouch excision or had recurrent CMV infection. Three patients had recurrent nonspecific pouchitis.
  
  
  CONCLUSIONS
  A high index of suspicion is needed to diagnose CMV of the pouch. An increase in stool frequency and fever in patients on immune suppression or in those who have failed empiric antibiotics should prompt assessment for CMV infection. Antiviral therapy seems to be effective, and postinfection pouch outcomes seem favorable, particularly in those presenting with their first episode of pouchitis.
authors: Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota.
authors: Jeffrey D
authors: JD
authors: McCurdy
authors: Edward V
authors: EV
authors: Loftus
authors: William J
authors: WJ
authors: Tremaine
authors: Thomas C
authors: TC
authors: Smyrk
authors: David H
authors: DH
authors: Bruining
authors: Darrell S
authors: DS
authors: Pardi
authors: Laura E
authors: LE
authors: Raffals
authors: John B
authors: JB
authors: Kisiel
authors: Nayantara
authors: N
authors: Coelho-Prabhu
authors: Sunanda V
authors: SV
authors: Kane
authors: William A
authors: WA
authors: Faubion
authors: Konstantinos A
authors: KA
authors: Papadakis
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D039021:Colonic Pouches / Q000473:pathology / Q000821:virology*; D003587:Cytomegalovirus / Q000472:pathogenicity; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019449:Pouchitis / Q000188:drug therapy / Q000473:pathology / Q000821:virology*; D016737:Proctocolectomy, Restorative; D011379:Prognosis; D012008:Recurrence; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir
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