Cytomegalovirus infection has been reported in ulcerative colitis, especially in severe, steroid-refractory disease.
However, its role in steroid-refractoriness remains unknown.
Dr Edomenech Germanstrias and colleagues from Spain evaluated the prevalence of cytomegalovirus disease in ulcerative colitis, the best diagnostic strategy, and the influence of disease activity and/or treatment in its development.
The team conducted a prospective, observational study including 114 subjects with active ulcerative colitis requiring intravenous steroids, steroid-refractory ulcerative colitis, inactive ulcerative colitis on mesalamine, inactive ulcerative colitis on azathioprine, and healthy controls.
|Cytomegalovirus disease was found in 6 steroid-refractory ulcerative colitis patients|
|Inflammatory Bowel Diseases|
Cytomegalovirus antibodies, pp65-antigenemia, and rectal biopsies for hematoxylin and eosin staining, immunohistochemistry, and cytomegalovirus-pp67 mRNA were performed.
These procedures were repeated after medical treatment only in patients with active ulcerative colitis.
Cytomegalovirus disease was defined by the presence of inclusion bodies and/or positive immunohistochemistry in colonic biopsies.
The team identified cytomegalovirus disease in 6 steroid-refractory, and cytomegalovirus-IgG-positive ulcerative colitis patients.
However, the researchers did not find cytomegalovirus disease among controls, inactive ulcerative colitis, or steroid-responding ulcerative colitis patients.
In 5 out of the 6 patients, cytomegalovirus disease was diagnosed after 7 to 10 days on cyclosporine.
Dr Germanstrias' team comments, "Cytomegalovirus disease in ulcerative colitis only affects seropositive, steroid-refractory ulcerative colitis patients."
"Steroid/cyclosporine treatment together with disease activity may predispose to latent colonic cytomegalovirus reactivation."
"The impact of antiviral therapy on the clinical outcome of these patients remains to be elucidated."