CYTOMEGALOVIRUS AS AN EXACERBATING FACTOR IN ULCERATIVE-COLITIS

Cytomegalovirus (CMV) colitis has been reported infrequently in patien ts with underlying inflammatory bower disease, and usually in those wh o are taking long-term corticosteroid drugs and who are potentially im munosuppressed. We report a 39-year-old man with longstanding ulcerati ve colitis, taking only sulfasalazine, who developed a viral prodrome followed by bloody diarrhea. Severe colitis was noted on endoscopy. He worsened with intravenous steroid and antibiotic drugs. Flexible sigm oidoscopy with biopsy before a contemplated colectomy revealed a moder ately active colitis with large cells containing intranuclear inclusio ns scattered throughout the biopsies, characteristic of CMV colitis. S erologic and immunologic studies suggested recent CMV infection. The p atient improved with intravenous ganciclovir and a steroid taper, and colectomy was avoided. CMV colitis is a potentially treatable cause of fulminant colitis.