Researchers from the University of Palermo, Italy, evaluated the prevalence and outcome of cytomegalovirus infection in a consecutive series of patients with severe steroid refractory colitis. All individuals were admitted to the team's institution from 1997 to 1999.
Among 62 patients with severe colitis, 55 with ulcerative colitis and 7 with Crohn's disease, 19 (30%) were resistant to intravenous steroids and bowel rest.
In all of them, rectal biopsies were examined for cytomegalovirus (the flexible proctoscopy being performed without air insufflation and limited to the first
10 cm). Buffy coat preparation on leukocytes was also performed to detect systemic infection. If cytomegalovirus was not detected, cyclosporine was started.
In 7 patients (5 with ulcerative colitis and 2 with Crohn's disease) out of 19 (36%) with refractory disease, cytomegalovirus was diagnosed in the rectal specimens as well as by buffy coat preparation.
|36% of patients with severe refractory colitis were infected with cytomegalovirus.
|American Journal of Gastroenterology|
Five patients went into remission after antiviral treatment (three with ganciclovir and two with foscarnet).
One patient did not respond and was operated on. In one patient, cytomegalovirus was found in the surgical specimen.
Researcher M. Cottone concluded on behalf of the group, "Cytomegalovirus infection is a frequent cause of severe refractory colitis. Rectal biopsy should always be performed in severe steroid-resistant colitis."