Cytomegalovirus Colitis in a Patient with Severe Treatment Refractory Ulcerative Colitis.

IF 1.8 Q3 GASTROENTEROLOGY & HEPATOLOGY Crohn's & Colitis 360 Pub Date : 2024-02-28 eCollection Date: 2024-01-01 DOI:10.1093/crocol/otae014
Michelle M Bao, Juliana M Kennedy, Michael T Dolinger, David Dunkin, Joanne Lai, Marla C Dubinsky
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Abstract

Background: Cytomegalovirus (CMV) can be reactivated in ulcerative colitis (UC), but its role in progression of inflammation is unclear. Risk factors include severe colitis and treatment with immunosuppressive medications, particularly corticosteroids and immunomodulators.

Methods: We report a case of cytomegalovirus colitis in a pediatric patient with pancolitis who had been refractory to aminosalicylate, infliximab, and ustekinumab and was in clinical remission and with transmural response on upadacitinib.

Results: This is a case of a 13-year-old male with UC refractory to multiple therapies who were in clinical remission on upadacitinib 30 mg daily. He developed an acute increase in symptoms and did not respond to therapy escalation with increased upadacitinib 45 mg daily for 2 weeks and prednisone for 1 week. He was diagnosed with cytomegalovirus colitis on flexible sigmoidoscopy biopsy. He was treated with intravenous ganciclovir with tapering of immunosuppressive regimen. Despite initial response, he underwent subtotal colectomy and subsequent restorative proctocolectomy with ileal pouch anal-anastomosis.

Conclusions: Despite our patient having multiple risk factors for developing CMV colitis, upadacitinib may have played a role when considering its known impact on the herpes family of viruses. CMV colitis should be evaluated for in any patient who presents with worsening symptoms without evidence of other infection or response to increase in therapy.

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严重难治性溃疡性结肠炎患者的巨细胞病毒性结肠炎。
背景:巨细胞病毒(CMV巨细胞病毒(CMV)可在溃疡性结肠炎(UC)中重新激活,但其在炎症进展中的作用尚不清楚。风险因素包括严重结肠炎和使用免疫抑制剂治疗,尤其是皮质类固醇激素和免疫调节剂:我们报告了一例儿童胰腺炎患者巨细胞病毒性结肠炎的病例,该患者曾对氨水杨酸盐、英夫利昔单抗和乌司替库单抗治疗难治,在服用达达替尼后病情得到临床缓解并出现跨膜反应:这是一例对多种疗法均难治的13岁男性UC患者,每天服用30毫克达帕替尼后临床缓解。他的症状出现急性加重,并且对每天增加达帕替尼 45 毫克治疗 2 周和泼尼松治疗 1 周的升级疗法没有反应。经柔性乙状结肠镜活检,他被诊断为巨细胞病毒结肠炎。他接受了静脉注射更昔洛韦治疗,并逐渐减少免疫抑制方案。尽管最初有所反应,但他还是接受了结肠次全切除术,随后又接受了修复性直肠结肠切除术和回肠袋肛门吻合术:结论:尽管我们的患者有多种患 CMV 结肠炎的风险因素,但考虑到达达替尼对疱疹病毒家族的已知影响,它可能起到了一定的作用。如果患者出现症状恶化,但无其他感染迹象或对增加治疗无反应,则应评估CMV结肠炎。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Crohn's & Colitis 360
Crohn's & Colitis 360 Medicine-Gastroenterology
CiteScore
2.50
自引率
0.00%
发文量
41
审稿时长
12 weeks
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