Prevalence of cytomegalovirus infection in severe refractory ulcerative and Crohn's colitis

OBJECTIVES Cytomegalovirus infection has been reported as a cause of refrac tory inflammatory bowel disease, but no data are available on its prevalenc e in severe colitis. The aim of this study was to evaluate the prevalence a nd outcome of cytomegalovirus infection in a consecutive series of patients with severe steroid refractory colitis admitted to our department from 199 7 to 1999. METHODS: Among 62 patients with severe colitis, 55 with ulcerative colitis and seven with Crohn's disease, 19 (30%) were resistant to intravenous ster oids and bowel rest. In all of them, rectal biopsies were examined for cyto megalovirus (the flexible proctoscopy being performed without air insufflat ion and limited to the first 10 cm). Buffy coat preparation on leukocytes w as also performed to detect systemic infection. If cytomegalovirus was not detected, cyclosporine was started. RESULTS: In seven (five with ulcerative colitis and two with Crohn's diseas e) out of 19 (36%) patients with refractory disease, cytomegalovirus was di agnosed in the rectal specimens as well as by buffy coat preparation. Five patients went into remission after antiviral treatment (three with ganciclo vir and two with foscarnet). One patient did not respond and was operated o n. In one patient, cytomegalovirus was found in the surgical specimen. CONCLUSIONS: Cytomegalovirus infection is a frequent cause of severe refrac tory colitis. Rectal biopsy should always be performed in severe steroid-re sistant colitis. (C) 2001 by Am. Cell. of Gastroenterology.