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Inflammatory Bowel Diseases:
doi: 10.1097/MIB.0b013e31828075ce
Original Clinical Article

Looking for Endoscopic Features of Cytomegalovirus Colitis: A Study of 187 Patients with Active Ulcerative Colitis, Positive and Negative for Cytomegalovirus

Iida, Takayuki MD*; Ikeya, Kentaro MD*; Watanabe, Fumitoshi MD*; Abe, Jinro MD*; Maruyama, Yasuhiko MD; Ohata, Akihiko MD; Teruyuki, Shimura MD; Sugimoto, Ken MD; Hanai, Hiroyuki MD*

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Abstract

Background:

Cytomegalovirus (CMV) is frequently detected in ulcerative colitis (UC) lesions of steroid-refractory patients. This has led to the suspicion that CMV might cause colitis and steroid refractoriness.

Methods:

During 2003 and 2011, 187 consecutive patients were divided into group I (n = 105), corticosteroid-free and thiopurine-free in the past 6 months, and group II (n = 82), all corticosteroid refractory. The combination of serum CMV immunoglobulin (Ig)M, CMV IgG, CMV antigenemia (Ag), and real-time polymerase chain reaction assays were performed to identify CMV(+) patients.

Results:

In group I, 79 patients were CMV IgG(+) and 26 patients were CMV IgG(−) and CMV IgM(−). In group II, 61 patients were CMV IgG(+), 1 CMV IgM(+), and 20 CMV IgG(−) and CMV IgM(−). All CMV IgG(+) patients were screened for CMV Ag. In group I, 6 of the 79 CMV IgG(+) patients were CMV Ag(+). In group II, 27 patients were CMV Ag(+). Colonoscopy was performed in all patients before screening for CMV. Similar colonoscopic features including punched out ulcers, geographic ulcers, and irregular ulcers were found in both CMV(+) and CMV(−) patients, without any striking difference between the 2 groups.

Conclusions:

CMV reactivation might be encouraged by immunosuppressive drugs, like corticosteroids, immunomodulators, and therefore, patients with UC are at a high risk of CMV reactivation, potentially exacerbating UC. However, this study of 187 patients, CMV(+) and CMV(−), could not find colonoscopic features unique to CMV, except that CMV might be one factor for steroid refractoriness, and UC exacerbation.

Copyright © 2013 Crohn's & Colitis Foundation of America, Inc.

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