Cytomegaloviral enterocolitis - Clinical associations and outcome

PURPOSE: Cytomegaloviral enterocolitis is an uncommon disorder that can com plicate inflammatory bowel disease. It is more common in patients with acqu ired immunodeficiency syndrome and can occur in patients on immunosuppressi ve therapy for autoimmune or inflammatory diseases and in allograft recipie nts. Mortality rates of up to 71 percent have been reported for cytomegalov iral enterocolitis; The aims of this study were 1) to identify the presenta tion, underlying medical conditions, treatment, and outcome of patients wit h cytomegaloviral enterocolitis and 2) to determine the prevalence of this infection in patients undergoing intestinal resection for inflammatory bowe l disease. METHODS: A retrospective chart review of patients with pathologi c evidence of cytomegaloviral enterocolitis from 1985 through 1996 was perf ormed. To determine the prevalence of this condition, the hospital discharg e database was searched for the diagnoses of ulcerative colitis and Crohn's disease in patients who underwent bowel resection. RESULTS: 93 patients (m ean age, 44 years; 66 percent males) had cytomegaloviral infection in the s mall intestine (n = 6), large intestine (n = 86), or appendix (n = 1). Pati ents with acquired immunodeficiency syndrome (n = 42), with ulcerative coli tis (n = II), with Crohn's disease (n = 11), receiving organ transplant (n = 12), receiving bone marrow transplant (n = 8), and in other immunosuppres sed states (n = II) comprised this study. Seventeen patients (18 percent) u nderwent intestinal resection, and the remaining 76 patients were treated m edically. Abdominal pain (77 vs. 37 percent; P < 0.01) and gastrointestinal bleeding (65 vs. 34 percent; P < 0.05) were more common presenting symptom s in patients who required resection than patients in the medically managed group. Mortality was 17.6 percent in the surgically managed group and 14.5 percent in the patients who were managed medically. The median duration of ulcerative colitis in patients with coexisting cytomegaroviral infection w as 12 months. The prevalence of cytomegaloviral enterocolitis was 4.6 perce nt in patients with ulcerative colitis and 0.8 percent in patients with Cro hn's disease. CONCLUSIONS: These data suggest that cytomegaloviral infectio n more frequently complicates ulcerative colitis than Crohn's disease. Furt hermore, a short and fulminant course of ulcerative colitis may indicate co existing cytomegaloviral infection. The overall low mortality in this retro spective study suggests that aggressive medical and surgical treatment impr oves survival in patients with cytomegaloviral enterocolitis.