CMV colitis

The prevalence of CMV infection in patients with IBD has been reported as 5% to 36%, and higher in patients with disease refractory to steroid therapy.

Also associated with AIDS or transplant patients.

Usually affects ileocecal area; may cause vasculitis, luminal thrombosis and associated severe necrotizing diseaseCMV burden is low so difficult to detect these cells; stool examinations usually normalEarly and rapid colonoscopy is beneficial in transplant patients 

The diagnosis of CMV colitis is based on serology, CMV antigen testing and colonscopy with biopsy. 

On endoscopy, discrete deep ulcers may be seen, although inflammatory changes resembling UC can also be found. 

Biopsies of the ulcer bed and surrounding mucosa must be performed in the appropriate setting to look for giant cells with inclusion bodies. 

Clinical suspicion should be aroused in the setting of immunocompromised patient but it is much rarer in immunocompetent patient.

When a patient with IBD is diagnosed with CMV infection, the immunomodulatory drugs should be stopped and the corticosteroids should be tapered to the lowest possible dose. Treatment of the infection is intravenous ganciclovir at 5 mg per kilogram of body weight twice daily for 14 days, followed by oral valacyclovir (Valtrex) 450 mg twice daily for 4 weeks.

CMV colitis

inclusion bodies