Outcome of cytomegalovirus infections in patients with inflammatory bowel disease

OBJECTIVE: The aim of this study was to determine the outcome of cytomegalo virus (CMV) infections complicating the course of inflammatory bowel diseas e (IBD). METHODS: The records and clinical courses were reviewed for all IBD patient s who were evaluated at the IBD Center of the Cedars-Sinai Medical Center a nd who developed CMV infection. RESULTS: Ten patients with severe, medically refractory IBD (five ulcerativ e colitis, three Crohn's colitis, and two indeterminate colitis) developed CMV infection. All but two were hospitalized with exacerbation of their und erlying disease and were receiving immunosuppressive treatment with steroid s, thiopurines, and/or cyclosporine at the time CMV infection was recognize d. Eight patients had documented colonic CMV tone had concurrent upper GI t ract involvement), one developed interstitial CMV and Pneumocystis carinii pneumonia, and one developed primary CMV mononucleosis. Prompt treatment wi th ganciclovir and withdrawal of immunosuppressive treatment resulted in gr adual improvement and induction of remission of the underlying IBD in five patients. The patient with concomitant CMV and P. carinii pneumonitis died. In two patients, treatment with ganciclovir did not alter the clinical cou rse of their LED, and one of them underwent colectomy. In one patient CMV w as found on the resected colonic specimen. One patient with primary CMV inf ection responded also to ganciclovir treatment. CONCLUSIONS: CMV infection may aggravate the course of seemingly refractory IBD in patients who either fail to respond or experience worsening of symp toms despite immunosuppressive therapy. Expedient evaluation, prompt treatm ent intervention with ganciclovir, and withdrawal of immunosuppressive trea tment may avoid complications and mortality. This regimen leads to improvem ent of the underlying IBD in most patients. (C) 2001 by Am. Coll. of Gastro enterology.