Cytomegalovirus infection in patients with inflammatory bowel disease

OBJECTIVE: It has been suggested that, in inflammatory bowel disease, cytom egalovirus behaves in the intestine as a nonpathogenic bystander, and even its finding in intestinal mucosa has unclear clinical relevance. We report our experience with a small series of patients with refractory inflammatory bowel disease and cytomegalovirus infection and their clinical outcome. METHODS AND RESULTS: Nine patients with moderate-severe attacks of inflamma tory bowel disease did not respond to i.v. prednisone (1 mg/kg/day) for a m ean of 24 days. Four of these patients were further treated with i.v. cyclo sporine A (4 mg/kg/day). Cytomegalovirus infection was diagnosed in two pat ients after resection for treatment failure. In the remaining patients, cyt omegalovirus infection was diagnosed in endoscopic mucosal biopsies and i.v . ganciclovir was then administered at a dose of 10 mg/kg/day for 2-3 wk. F ive of these patients went into clinical remission, allowing corticosteroid and cyclosporine A discontinuation. Follow-up biopsies were performed and in all cases cytomegalovirus could not be detected in the colonic tissue. T wo patients needed to be treated with intravenous cyclosporine A after anti viral therapy because of persistence of clinical symptoms despite the elimi nation of cytomegalovirus infection. CONCLUSIONS: Cytomegalovirus infection may play a role in the natural histo ry of refractory inflammatory bowel disease and in some of its complication s. The clearance of cytomegalovirus in colonic mucosa may lead some of thes e patients to remission. (C) 1999 by Am. Cell. of Gastroenterology.