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Synchronous cytomegalovirus and Clostridium difficile infection of the pouch: a trigger for chronic pouchitis?

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Abstract

Pouchitis occurs in up to one half of patients after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Cytomegalovirus (CMV) and Clostridium difficile are among the commonest secondary identifiable etiologies. A 17-year-old male with ulcerative colitis underwent IPAA due to refractory disease. Nine months later he experienced bloody diarrhea and fever. Laboratory testing and endoscopy confirmed pouch inflammation. Testing for C. difficile toxins A and B was positive. Histology revealed affluent inclusion bodies and immunohistochemistry detected reactivity against CMV protein. Treatment with metronidazole and vancomycin offered partial improvement, whereas the addition of gancyclovir led to a successful recovery. One month after completion of treatment symptoms recurred. Repeat testing precluded an identifiable infectious cause and the diagnosis of idiopathic chronic pouchitis was established. The patient is currently on maintenance treatment with the probiotic compound VSL#3.

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Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. 2nd Department of Surgery, Aretaieion Hospital, University of Athens, 76 Vas. Sofias Avenue, 115 28, Athens, Greece

    Ioannis Papaconstantinou, Dionysios Dellaportas & George Polymeneas

  2. Department of Gastroenterology, ‘Alexandra’ General Hospital, 80 Vas. Sofias Avenue, 115 28, Athens, Greece

    Evanthia Zampeli, Charalambos Giannopoulos, Maria Sotiropoulou & Spyros Michopoulos

  3. Academic Department of Gastroenterology, First Department of Propaedeutic Internal Medicine, Laikon General Hospital, Ethnikon and Kapodistriakon University, 17 Aghiou Thoma, 115 27, Athens, Greece

    Giorgos Bamias

Authors
  1. Ioannis Papaconstantinou
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  2. Evanthia Zampeli
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  3. Dionysios Dellaportas
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  4. Charalambos Giannopoulos
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  5. Maria Sotiropoulou
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  6. George Polymeneas
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  7. Giorgos Bamias
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  8. Spyros Michopoulos
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Correspondence to Evanthia Zampeli.

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Papaconstantinou, I., Zampeli, E., Dellaportas, D. et al. Synchronous cytomegalovirus and Clostridium difficile infection of the pouch: a trigger for chronic pouchitis? . Clin J Gastroenterol 7, 132–135 (2014). https://doi.org/10.1007/s12328-014-0458-6

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  • DOI: https://doi.org/10.1007/s12328-014-0458-6

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