Cytomegalovirus colitis complicating ulcerative colitis in the steroid-naive patient

We report a case of cytomegalovirus (CMV) presenting as acute refractory co litis in a patient with a pre-existing 14-month history of ulcerative colit is (UC) who had never previously been treated with corticosteroids or immun osuppressants. A review of existing literature and previous cases of patien ts with coincident CMV and UC are examined, stratifying these cases based u pon absence or presence of corticosteroid use. To date, only five previous case reports of CMV colitis in patients naive to corticosteroids have been described, and only one previous case has had UC diagnosed over 4 wk before the development of CMV colitis. We further discuss the relationship betwee n these two diseases as well as the diagnosis, treatment, patient character istics, and outcome of CMV infection of the colon in patients with underlyi ng UC, We discuss the need to consider the diagnosis of CMV colitis in pati ents with refractory UC who are not receiving corticosteroid treatment as w ell as those who are refractory and are being treated with immunosuppressan ts and/or corticosteroids. (C) 2001 by Am. Cell. of Gastroenterology.