Cytomegalovirus Colitis in a Patient With Ulcerative Colitis on Vedolizumab Monotherapy

Meeralam, Yaser; Qurashi, Bushra Al; Masoudi, Assel Al; Alhejaili, Talal L; Khayat, Mohammed; Aljoaid, Anas M; Harthi, Wallaa Al; Hafiz, Waleed; Shariff, Mohammed K

doi:10.7759/cureus.35473

Cited by 3 publications

(5 citation statements)

References 14 publications

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“…While there is no standard definition for CMV colitis, the presence of inclusion bodies on hematoxylin and eosin (H&E) stain, positive IHC stained cells in colonic tissue, and/or tissue PCR from endoscopic biopsy is recommended for diagnosis. 12 , 17 CMV tissue load by PCR thresholds or histologic criteria appears to be predictive of whether CMV is more likely a pathogenic driver or an incidental finding in the setting of severe colitis. 17 Patients who meet study-specific designated criteria for high-grade CMV colitis have been reported to have higher rates of colectomy and are less likely to respond to corticosteroid treatment.…”

Section: Discussionmentioning

confidence: 98%

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Cytomegalovirus Colitis in a Patient with Severe Treatment Refractory Ulcerative Colitis

Bao,

Kennedy,

Dolinger

et al. 2024

Crohn's &Amp; Colitis 360

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Background Cytomegalovirus can be reactivated in ulcerative colitis, but its role in progression of inflammation is unclear. Risk factors include severe colitis and treatment with immunosuppressive medications, particularly corticosteroids and immunomodulators. Methods We report a case of cytomegalovirus colitis in a pediatric patient with pancolitis who had been refractory to aminosalicylate, infliximab, and ustekinumab and was in clinical remission and with transmural response on upadacitinib. Results This is a case of a 13-year-old-male with ulcerative colitis refractory to multiple therapies who was in clinical remission on upadacitinib 30 mg daily. He developed an acute increase in symptoms and did not respond to therapy escalation with increased upadacitinib 45 mg daily for 2 weeks and prednisone for 1 week. He was diagnosed with cytomegalovirus colitis on flexible sigmoidoscopy biopsy. He was treated with intravenous ganciclovir with tapering of immunosuppressive regimen. Despite initial response, he underwent subtotal colectomy and subsequent restorative proctocolectomy with ileal pouch anal-anastomosis. Conclusions Despite our patient having multiple risk factors for developing CMV colitis, upadacitinib may have played a role when considering its known impact on the herpes family of viruses. CMV colitis should be evaluated for in any patient who presents with worsening symptoms without evidence of other infection or response to increase in therapy.

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Section: Discussionmentioning

confidence: 98%

“… 11 Safety data from vedolizumab suggests no increased risk, although a case has been reported of a patient who developed CMV colitis on vedolizumab monotherapy and responded to antiviral therapy. 12 …”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus Colitis in a Patient with Severe Treatment Refractory Ulcerative Colitis

Bao,

Kennedy,

Dolinger

et al. 2024

Crohn's &Amp; Colitis 360

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“…Thus, the differential diagnosis for GIB in adults encompasses a range of conditions due to its nonspecific clinical presentation, leading to misdiagnosis and delay. The main differential diagnoses include inflammatory bowel diseases (IBD) such as Crohn's disease (CD), intestinal tuberculosis, and other granulomatous diseases [ 10 , 11 ]. Additionally, GIB should be considered in the differential diagnosis of mucormycosis, particularly in cases of colonic masses and eosinophilic intestinal inflammation [ 12 , 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Occasionally abscess formation in the affected area can be seen appearing as a localized collection of pus or fluid; however, these are not specific to GIB [ 9 , 17 ]. Colonoscopy aids in the diagnosis, but endoscopic features are typical of inflammatory processes, such as ulcerated polypoidal or nodular mucosa with necrosis and exudates [ 1 , 10 , 11 , 14 ]. Biopsies of the involved organ, colon, or liver often show features of nonspecific inflammation.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal Basidiobolomycosis: A Case Series

Meeralam,

Basfar,

Alzanbagi

et al. 2024

Cureus

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Gastrointestinal basidiobolomycosis (GIB) is a rare fungal infection caused by Basidiobolus ranarum, a saprophytic fungus that belongs to the class of Basidiobolomycetes. It mainly infects immunocompetent individuals and is mainly found in arid tropical and subtropical regions, including Southwestern America, Saudi Arabia, Africa, and Asia. Not surprisingly, a great number of human infections have been reported from these warm, humid climate regions that are felicitous for the growth of this fungus, especially from the southern region of Saudi Arabia and Arizona in the United States of America. GIB is easily misdiagnosed as malignancy, inflammatory bowel disease, diverticulitis, lymphoma, and chronic intestinal infections due to its rarity. In this case series, we summarize the clinical features, imaging, histopathological features, and treatment of patients diagnosed with GIB in our institution.

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“…38 Even though its effectiveness has not been established in extensive patient cohorts, recent case studies have supported the use of vedolizumab in the treatment of steroid-resistant colitis with CMV reactivation. 88…”

Section: How To Manage CMV Colitis With Immunosuppressivementioning

confidence: 99%

Cytomegalovirus Infection in Adult Patients with Inflammatory Bowel Disease: A Literature Review

Momayaz Sanat,

Siami,

Alatab

et al. 2024

Arch Iran Med

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Human cytomegalovirus (HCMV) is classified within the Herpesvirales order and is prevalent in 50%‒80% of the general population. Most carriers experience this infection without noticeable clinical symptoms. HCMV causes a lifelong latent infection that can be reactivated due to immune disorders and inflammation. The reactivation of HCMV becomes particularly significant when it coincides with inflammatory bowel disease (IBD). While cytomegalovirus (CMV) colitis in IBD patients was identified years ago, the role of CMV in triggering flare-ups, acute severe colitis, treatment resistance, and other outcomes in IBD patients experiencing CMV reactivation remains a subject of ongoing debate. In this review, we aim to address an updated insight into aspects related to the CMV colitis in IBD patients including epidemiology, risk factors, clinical features, diagnostic tests, histology, place of immunosuppressants and indications for antiviral treatment. We suggest for personalized and thorough assessment based on the disease phase and colitis severity when prescribing drugs to these patients. Furthermore, we emphasize the importance of regular patient follow-up to monitor drug side effects, ensuring treatment success, and minimizing the risk of colectomy.

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Cytomegalovirus Colitis in a Patient With Ulcerative Colitis on Vedolizumab Monotherapy

Cited by 3 publications

References 14 publications

Cytomegalovirus Colitis in a Patient with Severe Treatment Refractory Ulcerative Colitis

Cytomegalovirus Colitis in a Patient with Severe Treatment Refractory Ulcerative Colitis

Gastrointestinal Basidiobolomycosis: A Case Series

Cytomegalovirus Infection in Adult Patients with Inflammatory Bowel Disease: A Literature Review

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