To the Editor,Predisposing factors for urgent colectomy in patients with ulcerative colitis (UC) are not completely known, but it seems that cytomegalovirus (CMV) infection may have a potential pathogenic role. Maher et al.[1] recently published in this journal that CMV infection is associated with steroid-refractoriness; however, the implication of CMV infection remains controversial and its presence is not always investigated [2][3][4][5][6]. Toxic megacolon and steroidrefractoriness in patients with UC are indications for surgical treatment, but it is unclear if CMV infection is present in both clinical presentations. The aim of medical treatment in severely active UC patients includes avoiding surgery; therefore, investigating the presence of CMV can lead to indicate antiviral treatment along with immunosuppressive therapy and probably avoid colectomy.We performed a review of our database, clinical files, and colectomy specimens of patients with UC. Between 1988 and 2009, a total of 355 patients with UC were on a surveillance program for colorectal cancer: 192 (54%) with pancolitis, and 163 (46%) with limited colitis. Colectomy for reasons other than dysplasia was performed in 47 patients. In six out of 47 patients, information was incomplete; therefore, 41 were analyzed. Colectomy was indicated for toxic megacolon in 23/41 (56%) and for severely active intravenous steroid-refractory disease (hydrocortisone 300-400 mg/day for 3-7 days) in 18/41 (44%). In this group, 39 (95%) had pancolitis and two (5%) had limited colitis, suggesting that patients with extensive location of UC are more likely to require surgical treatment (p \ 0.0001). Regarding CMV infection, we performed a review of colectomy specimens; paraffinized tissues were
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