title: Protracted primary cytomegalovirus infection presenting as ileoanal pouchitis in a non-immunosuppressed patient: a case report.
abstract: BACKGROUND
  Pouchitis often occurs after proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis. It is usually deemed idiopathic and commonly responds to antibacterial therapy. To date, only a few cases of cytomegalovirus pouchitis have been documented, and only a single report describes pouchitis in a case of assumed primary cytomegalovirus infection.
  
  
  METHODS
  A 26-year-old Caucasian woman underwent proctocolectomy and ileal pouch-anal anastomosis for refractory ulcerative colitis and adenocarcinoma. After 28 months she developed bloody diarrhoea, abdominal pain, fever, nausea and general malaise suggesting severe pouchitis. Antibiotic treatment reduced humoral inflammation, but failed to resolve her fever. A pouchoscopy revealed distinct pouchitis, and cytomegalovirus infection was diagnosed from pouch biopsies by polymerase chain reaction as well as conventional histology and immunohistochemistry. The infection was confirmed in her blood by polymerase chain reaction and pp65 antigen test, and was clearly defined as the 'primary' infection by serial serological tests. Intravenous treatment with ganciclovir (10mg/kg body weight/day) led to resolution of symptoms and negative cytomegalovirus deoxyribonucleic acid and pp65 within a few days. When symptoms and laboratory evidence of cytomegalovirus infection recurred a few days after completing 20 days of therapy with ganciclovir and valganciclovir, a second course of ganciclovir treatment was initiated.
  
  
  CONCLUSIONS
  Cytomegalovirus infection of the ileoanal pouch is an important differential diagnosis of pouchitis even in non-immunosuppressed patients and can be treated with ganciclovir.
authors.forename: Christian
authors.initials: C
authors.lastname: Rupp
authors.forename: Esther
authors.initials: E
authors.lastname: Herpel
authors.forename: Paul
authors.initials: P
authors.lastname: Schnitzler
authors.forename: Anna
authors.initials: A
authors.lastname: Zawierucha
authors.forename: Philipp
authors.initials: P
authors.lastname: Zwickel
authors.forename: Lukas
authors.initials: L
authors.lastname: Klute
authors.forename: Martina
authors.initials: M
authors.lastname: Kadmon
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Heidelberg, INF 410, 69120 Heidelberg, Germany. annika.gauss@med.uni-heidelberg.de.
authors.forename: Annika
authors.initials: A
authors.lastname: Gauss
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D007121:Immunocompetence; D019449:Pouchitis / Q000175:diagnosis* / Q000188:drug therapy / Q000821:virology; D016737:Proctocolectomy, Restorative
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir