Brief Article
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World J Gastrointest Pathophysiol. Feb 15, 2013; 4(1): 18-23
Published online Feb 15, 2013. doi: 10.4291/wjgp.v4.i1.18
Cytomegalovirus positive ulcerative colitis: A single center experience and literature review
Uri Kopylov, Gila Sasson, Bella Geyshis, Michal Tepperberg Oikawa, Iris Barshack, Rami Eliakim, Shomron Ben-Horin
Uri Kopylov, Gila Sasson, Rami Eliakim, Shomron Ben-Horin, Department of Gastroenterology, Sheba Medical Center, Ramat Gan 52621, Israel
Bella Geyshis, Internal Medicine D, Sheba Medical Center, Ramat Gan 52621, Israel
Michal Tepperberg Oikawa, Central Virology Laboratory, Public Health Laboratories, Israel Ministry of Health, Ramat Gan 52621, Israel
Iris Barshack, Department of Pathology, Sheba Medical Center, Ramat Gan 52621, Israel
Author contributions: Kopylov U and Ben-Horin S contributed to collection and analysis of data, drafting of the manuscript; Sasson G and Geyshis B contributed to collection of data; Oikawa MT contributed to data collection and analysis; Barshack I and Eliakim R contributed to critical review of the data and the manuscript for important scientific input; all authors reviewed the draft and final version of the manuscript.
Supported by Lecturer Fees from Abbott and Shering-Plough
Correspondence to: Uri Kopylov, MD, Department of Gastroenterology, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel. ukopylov@gmail.com
Telephone: +972-3-5302660 Fax: +972-3-5302660
Received: November 8, 2012
Revised: January 28, 2013
Accepted: February 5, 2013
Published online: February 15, 2013
Processing time: 146 Days and 14.5 Hours
Abstract

AIM: To compare the clinical outcome of cytomegalovirus (CMV)-positive ulcerative colitis (UC) patients with and without antiviral therapy.

METHODS: This was a retrospective case-controlled study. The database of UC patients in our institution was scanned for documented presence of CMV on colonic biopsies. Demographics, clinical data, endoscopy findings and pathology reports were extracted from the patients’ charts and electronic records. When available, the data from colonoscopies preceding and following the diagnosis of colonic CMV infection were also extracted. The primary outcomes of the study were colectomy/death during hospitalization and the secondary outcomes were colectomy/death through the course of the follow-up.

RESULTS: Thirteen patients were included in the study, 7 (53.5%) of them were treated with gancyclovir and 6 (46.5%) were not. Patients treated with antivirals presented with a more severe disease and 57% of them were treated with cyclosporine or infliximab before initiation of gancyclovir, while none of the patients without antivirals required rescue therapy. One patient died and another patient underwent urgent colectomy during hospitalization, both of them from the gancyclovir-treatment group. For the entire follow-up time (13 ± 13 mo), a total of 3 colectomies and one death occurred, all among the antiviral-treated patients (for colectomy: 3/7 vs 0/6 patients, P = 0.19; for combined adverse outcome: 4/7 vs 0/6 patients, P = 0.07). In 9/13 patients, immunohistochemistry for CMV was performed on biopsies obtained during a subsequent colonoscopy and was positive in one patient only.

CONCLUSION: Gancyclovir-treated patients had a more severe disease and outcome, probably unrelated to antiviral therapy. Immunohistochemistry-CMV-positive patients with mild disease may recover without antiviral therapy.

Keywords: Ulcerative colitis; Cytomegalovirus; Gancyclovir; Cyclosporine; Immunohistochemistry