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Cytomegalovirus Infection in Patients with Active Inflammatory Bowel Disease

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Abstract

Background

The reported prevalence of cytomegalovirus (CMV) infection with active inflammatory bowel disease (IBD) is highly variable, and whether CMV negatively impacts the clinical course is controversial.

Aims

The aim of this study was to determine the prevalence of CMV in patients with active ulcerative colitis (UC) or Crohn’s disease (CD) and compare the course of disease in patients with and without CMV.

Methods

Consecutive patients with acute exacerbations of active IBD colitis had immunohistochemistry staining for CMV antigen performed on archived specimens. Clinical features were retrospectively reviewed.

Results

Twelve (10%) of 122 UC patients had CMV, and 0/20 patients with CD had CMV. Of 12 UC patients with CMV infection, seven were not taking steroids or immunosuppressives at their index flare. UC patients with CMV were more likely to have leukocytosis (OR = 5.3, 95% CI 1.5–18.2), require hospitalization (OR = 4.9, 95% CI 1.2–19.0), and be hospitalized ≥7 days (OR = 5.0, 95% CI 1.6–21.3) compared to patients without CMV. Of 12 UC patients with CMV, ten (83%) were treated for their index flare with steroids or 6-mercaptopurine. Only one patient (8%) was treated for CMV infection which occurred 14 months after index endoscopy. Over the 6 months after the index flare, UC patients with CMV had a higher frequency of IBD-related hospitalizations compared to patients without CMV (50 vs. 24%, P = 0.021), but none required surgery or died.

Conclusions

The prevalence of CMV with active UC was 10%. Although CMV infection may be a marker of disease severity, our results suggest it does not cause severe morbidity or mortality in a general population of patients with a UC flare.

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Abbreviations

CMV:

Cytomegalovirus

IBD:

Inflammatory bowel disease

UC:

Ulcerative colitis

CD:

Crohn’s disease

H&E:

Hematoxylin and eosin

IHC:

Immunohistochemistry

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Conflict of interest statement

None of the authors have conflict of interest or funding source to declare in connection with this study.

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Authors and Affiliations

  1. Department of Medicine, Keck School of Medicine University of Southern California, Los Angeles, CA, USA

    John J. Kim, Nicole Simpson, Renee DeBose & Loren Laine

  2. Department of Pathology, Keck School of Medicine University of Southern California, Los Angeles, CA, USA

    Nancy Klipfel & Nancy Barr

  3. GI Division, Keck School of Medicine, 2025 Zonal Ave, Los Angeles, CA, 90033, USA

    Loren Laine

Authors
  1. John J. Kim
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  2. Nicole Simpson
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  3. Nancy Klipfel
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  4. Renee DeBose
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  6. Loren Laine
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Correspondence to Loren Laine.

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Kim, J.J., Simpson, N., Klipfel, N. et al. Cytomegalovirus Infection in Patients with Active Inflammatory Bowel Disease. Dig Dis Sci 55, 1059–1065 (2010). https://doi.org/10.1007/s10620-010-1126-4

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  • DOI: https://doi.org/10.1007/s10620-010-1126-4

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