Cytomegalovirus colitis during mycophenolate mofetil therapy for Wegener'sgranulomatosis

Cytomegalovirus (CMV) infection of the gastrointestinal tract is an increas ingly recognized cause of morbidity and mortality during the course of HIV infection and in association with immunosuppressive pharmacotherapy. Mycoph enolate mofetil, a novel immunosuppressive drug, is currently used in renal transplant recipients and is under evaluation for a variety of disorders. There is preliminary evidence to suggest that CMV reactivation may be more common during treatment with mycophenolate than with other immunosuppressiv e drugs. We present the case of a 59-year-old male with Wegener's granuloma tosis who received mycophenolate and presented with guaiac-positive diarrhe a 8 weeks after recovery from Salmonella brandenburg infection, CMV serolog y and assays for CMV antigens were entirely negative. Colonoscopy demonstra ted pancolitis and examination of the specimens disclosed CMV infection. Ga nciclovir was administered and the patient made an uneventful recovery. We discuss aspects of gastrointestinal CMV infection with an emphasis on pitfa lls in diagnosis and the association with mycophenolate mofetil treatment. We also speculate as to the potential role of previous Salmonella infection and proinflammatory cytokines in CMV reactivation. In summary, when using mycophenolate, clinicians should be more aware of CMV reactivation and dise ase. Copyright (C) 2000 S. Karger AG, Basel.