Acute cytomegalovirus infection in an immunocompetent patient with ulcerative colitis: A case report

  • Authors:
    • Toshihide Maeda
    • Hiroyasu Sakai
    • Noritaka Ozawa
    • Tomohiko Sugiyama
    • Jun Takada
    • Masaya Kubota
    • Takashi Ibuka
    • Yohei Shirakami
    • Hiroshi Araki
    • Masahito Shimizu
  • View Affiliations

  • Published online on: July 26, 2019     https://doi.org/10.3892/etm.2019.7823
  • Pages: 2271-2277
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Abstract

Cytomegalovirus (CMV) is a ubiquitous member of the Herpesviridae family that can present with a variety of clinical manifestations, including encephalitis, retinitis, interstitial pneumonia and colitis. These serious symptoms are generally observed as opportunistic infections in immunocompromised hosts, including patients with acquired immunodeficiency syndrome and those receiving steroids and/or immunosuppressants. Symptomatic CMV infections in patients with ulcerative colitis are found in patients treated with steroids and/or immunosuppressants but rarely affect those who are not taking these agents. The present study reported the case of a young patient without concurrent use of immunosuppressive agents for the treatment of ulcerative colitis. The patient presented with acute mononucleosis and colitis caused by primary CMV infection. This was characterized by the presence of atypical lymphocytes and hepatosplenomegaly, elevation of transaminase levels, serology‑positive anti‑CMV IgM, and CMV antigenemia. Additionally, CMV‑positive cells were histologically detected in colonic biopsy specimens. The patient's symptoms and clinical parameters improved following initiation of intravenous ganciclovir. It was concluded that even if patients with ulcerative colitis are not treated with steroids and/or immunosuppressants, significant attention should be paid to acute CMV infections in the context of severe or persistent colonic inflammation.

References

1 

de la Hoz RE, Stephens G and Sherlock C: Diagnosis and treatment approaches of CMV infections in adult patients. J Clin Virol. 25 (Suppl 2):S1–S12. 2002. View Article : Google Scholar : PubMed/NCBI

2 

Gandhi MK and Khanna R: Human cytomegalovirus: Clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis. 4:725–738. 2004. View Article : Google Scholar : PubMed/NCBI

3 

Berk T, Gordon SJ, Choi HY and Cooper HS: Cytomegalovirus infection of the colon: A possible role in exacerbations of inflammatory bowel disease. Am J Gastroenterol. 80:355–360. 1985.PubMed/NCBI

4 

Ikeda K, Nakajima S, Tanji K, Hirai T, Uomori K, Morimoto S, Tomita S, Fukunaga M, Tamura N and Sekigawa I: Intestinal perforation due to hemorrhagic Cytomegalovirus enteritis in a patient with severe uncontrolled lupus nephritis: A case and review of the literature. Rheumatol Int. 37:1395–1399. 2017. View Article : Google Scholar : PubMed/NCBI

5 

Babyatsky MW, Keroack MD, Blake MA, Rosenberg ES and Mino-Kenudson M: Case records of the Massachusetts General Hospital. Case 35-2007. A 30-year-old man with inflammatory bowel disease and recent onset of fever and bloody diarrhea. N Engl J Med. 357:2068–2076. 2007. View Article : Google Scholar : PubMed/NCBI

6 

Dimitroulia E, Spanakis N, Konstantinidou AE, Legakis NJ and Tsakris A: Frequent detection of cytomegalovirus in the intestine of patients with inflammatory bowel disease. Inflamm Bowel Dis. 12:879–884. 2006. View Article : Google Scholar : PubMed/NCBI

7 

Galiatsatos P, Shrier I, Lamoureux E and Szilagyi A: Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci. 50:609–616. 2005. View Article : Google Scholar : PubMed/NCBI

8 

Papadakis KA, Tung JK, Binder SW, Kam LY, Abreu MT, Targan SR and Vasiliauskas EA: Outcome of cytomegalovirus infections in patients with inflammatory bowel disease. Am J Gastroenterol. 96:2137–2142. 2001. View Article : Google Scholar : PubMed/NCBI

9 

Khan TV and Toms C: Cytomegalovirus colitis and subsequent new diagnosis of inflammatory bowel disease in an immunocompetent host: A case study and literature review. Am J Case Rep. 17:538–543. 2016. View Article : Google Scholar : PubMed/NCBI

10 

Kishore J, Ghoshal U, Ghoshal UC, Krishnani N, Kumar S, Singh M and Ayyagari A: Infection with cytomegalovirus in patients with inflammatory bowel disease: Prevalence, clinical significance and outcome. J Med Microbiol. 53:1155–1160. 2004. View Article : Google Scholar : PubMed/NCBI

11 

Pillet S, Pozzetto B and Roblin X: Cytomegalovirus and ulcerative colitis: Place of antiviral therapy. World J Gastroenterol. 22:2030–2045. 2016. View Article : Google Scholar : PubMed/NCBI

12 

Römkens TE, Bulte GJ, Nissen LH and Drenth JP: Cytomegalovirus in inflammatory bowel disease: A systematic review. World J Gastroenterol. 22:1321–1330. 2016. View Article : Google Scholar : PubMed/NCBI

13 

Ohnuki Y, Moriya Y, Yutani S, Mizuma A, Nakayama T, Ohnuki Y, Uda S, Inomoto C, Yamamoto S, Nakamura N and Takizawa S: Eosinophilic granulomatosis with polyangiitis (churg-strauss syndrome) complicated by perforation of the small intestine and cholecystitis. Intern Med. 57:737–740. 2018. View Article : Google Scholar : PubMed/NCBI

14 

Ikeda K, Takasaki Y and Sekigawa I: Rapid onset of small intestinal perforation after successful steroid treatment in eosinophilic granulomatosis with polyangiitis. Mod Pheumatol. 26:968–970. 2016.

15 

Seo M, Okada M, Yao T, Ueki M, Arima S and Okumura M: An index of disease activity in patients with ulcerative colitis. Am J Gastroenterol. 87:971–976. 1992.PubMed/NCBI

16 

Rachmilewitz D: Coated mesalazine (5-aminosalicylic acid) versus sulphasalazine in the treatment of active ulcerative colitis: A randomized trial. BMJ. 298:82–86. 1989. View Article : Google Scholar : PubMed/NCBI

17 

Eddleston M, Peacock S, Juniper M and Warrell DA: Severe cytomegalovirus infection in immunocompetent patients. Clin Infect Dis. 24:52–56. 1997. View Article : Google Scholar : PubMed/NCBI

18 

Farmer GW, Vincent MM, Fuccillo DA, Horta-Barbosa L, Ritman S, Sever JL and Gitnick GL: Viral investigations in ulcerative colitis and regional enteritis. Gastroenterology. 65:8–18. 1973. View Article : Google Scholar : PubMed/NCBI

19 

Ho M: The history of cytomegalovirus and its disease. Med Microbiol Immunol. 197:65–73. 2008. View Article : Google Scholar : PubMed/NCBI

20 

Moonka D, Furth EE, MacDermott RP and Lichtenstein GR: Pouchitis associated with primary cytomegalovirus infection. Am J Gastroenterology. 93:264–266. 1998. View Article : Google Scholar

21 

Rachima C, Maoz E, Apter S, Thaler M, Grossman E and Rosenthal T: Cytomegalovirus infection associated with ulcerative colitis in immunocompetent individuals. Postgrad Med J. 74:486–489. 1998. View Article : Google Scholar : PubMed/NCBI

22 

Kraus M, Meyenberger C and Suter W: Generalized intestinal CMV infection with protein-losing syndrome in ulcerative colitis. Schweiz Med Wochenschr. 130:1600–1605. 2000.PubMed/NCBI

23 

Osaki R, Andoh A, Tsujikawa T, Ogawa A, Koizumi Y, Nakahara T, Hata K, Sasaki M, Saito Y and Fujiyama Y: Acute cytomegalovirus infection superimposed on corticosteroid-naïve ulcerative colitis. Intern Med. 47:1341–1344. 2008. View Article : Google Scholar : PubMed/NCBI

24 

Inoue K, Wakabayashi N, Fukumoto K, Yamada S, Bito N, Yoshida N, Katada K, Uchiyama K, Ishikawa T, Handa O, et al: Toxic megacolon associated with cytomegalovirus infection in a patient with steroid-naïve ulcerative colitis. Intern Med. 51:2739–2743. 2012. View Article : Google Scholar : PubMed/NCBI

25 

Lancini D, Faddy HM, Flower R and Hogan C: Cytomegalovirus disease in immunocompetent adults. Med J Aust. 201:578–580. 2014. View Article : Google Scholar : PubMed/NCBI

26 

Takeda N, Isonuma H, Sekiya S, Ebe T, Matsumoto T and Watanabe K: Studies of anti-cytomegalovirus IgG antibody rate and cytomegalovirus mononucleosis in adults. Kansenshogaku Zasshi. 75:775–779. 2001. View Article : Google Scholar : PubMed/NCBI

27 

Pokorska-Śpiewak M, Niezgoda A, Gołkowska M, Czech-Kowalska J, Gruszfeld D, Dobrzańska A, Styczyński J and Marczyńska M: Recommendations for the diagnosis and treatment of CMV infections. Polish Society of epidemiology and infectious disease. Przegl Epidemiol. 70:297–310. 2016.PubMed/NCBI

28 

Cooper HS, Raffensperger EC, Jonas L and Fitts WT Jr: Cytomegalovirus inclusions in patients with ulcerative colitis and toxic dilation requiring colonic resection. Gastroenterology. 72:1253–1256. 1977.PubMed/NCBI

29 

Sidi S, Graham JH, Razvi SA and Banks PA: Cytomegalovirus infection of the colon associated with ulcerative colitis. Arch Surg. 114:857–859. 1979. View Article : Google Scholar : PubMed/NCBI

30 

Pfau P, Kochman ML, Furth EE and Lichtenstein GR: Cytomegalovirus colitis complicating ulcerative colitis in the steroid-naïve patient. Am J Gastroenterol. 96:895–899. 2001. View Article : Google Scholar : PubMed/NCBI

31 

Kopylov U, Sasson G, Geyshis B, Oikawa MT, Barshack I, Eliakim R and Ben-Horin S: Cytomegalovirus positive ulcerative colitis: A single center experience and literature review. World J Gastrointest Pathophysiol. 4:18–23. 2013. View Article : Google Scholar : PubMed/NCBI

Related Articles

Journal Cover

September 2019
Volume 18 Issue 3

Print ISSN: 1792-0981
Online ISSN:1792-1015

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
APA
Maeda, T., Sakai, H., Ozawa, N., Sugiyama, T., Takada, J., Kubota, M. ... Shimizu, M. (2019). Acute cytomegalovirus infection in an immunocompetent patient with ulcerative colitis: A case report. Experimental and Therapeutic Medicine, 18, 2271-2277. https://doi.org/10.3892/etm.2019.7823
MLA
Maeda, T., Sakai, H., Ozawa, N., Sugiyama, T., Takada, J., Kubota, M., Ibuka, T., Shirakami, Y., Araki, H., Shimizu, M."Acute cytomegalovirus infection in an immunocompetent patient with ulcerative colitis: A case report". Experimental and Therapeutic Medicine 18.3 (2019): 2271-2277.
Chicago
Maeda, T., Sakai, H., Ozawa, N., Sugiyama, T., Takada, J., Kubota, M., Ibuka, T., Shirakami, Y., Araki, H., Shimizu, M."Acute cytomegalovirus infection in an immunocompetent patient with ulcerative colitis: A case report". Experimental and Therapeutic Medicine 18, no. 3 (2019): 2271-2277. https://doi.org/10.3892/etm.2019.7823