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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*

doi: 10.1097/MIB.0b013e31828075ce
Original Clinical Article

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.

Article first published online 9 April 2013

*Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, Hamamatsu, Japan

Department of Gastroenterology, Fujieda Municipal Hospital, Fujieda, Japan; and

Department of Gastroenterology, Hamamatsu University school of Medicine, Hamamatsu, Japan.

Reprints: Hiroyuk Hanai, MD, Centre for Gastroenterology and Inflammatory Bowel Disease Research, Hamamatsu South Hospital, 26 Shirowacho, Hamamatsu 430-0846, Japan (e-mail:

The authors have no conflicts of interest to disclose.

Received August 13, 2012

Accepted August 13, 2012

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