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• W2977302839 abstract "Purpose: Cytomegaolvirus (CMV) is a double-stranded DNA virus member of the herpes family. The T-cell-mediated immune system is responsible for host infection response and surveillance. Primary infection usually manifests as mononucleosis, or has nonspecific symptoms. Severe organ involvement is uncommon in the immunocompetent. A 21-year-old male was referred to GI clinic after two emergency room visits for abdominal pain, diarrhea, and scant hematochezia. He was previously diagnosed with hemorrhoids and anal fissure, treated with supportive care. His history and physical was consistent with colitis/proctitis, with left lower quadrant abdominal pain, anal fissure, and severe perianal tenderness, confirmed with CT imaging. He was admitted for further evaluation, and underwent flexible sigmoidoscopy with patchy areas of edematous, erythematous, friable mucosa with areas of ulceration, and granulation visually similar to Crohn's. Treatment was withheld pending biopsies, which were suggestive of reactive viral process. CMV immunohistochemical stains demonstrated cytoclasmic inclusion bodies, and serum CMV antibody and PCR testing were positive. Treatment with ganciclovir was initiated with slow improvement. He subsequently was lost to follow-up until a subsequent emergency room visit with positive tests for chlamydia and gonorrhoeae. Cytomegalovirus exposure is highly prevalent worldwide, with an estimated 40-100% of middle-age adults having serologic evidence of exposure. Rarely does infection in the immunocompetent require hospitalization. Severe infection most commonly causes hepatitis, colitis, encephalopathy, or pneumonia, with multiorgan involvement carrying poorer prognosis. Severe infection should prompt evaluation for an immunecompromised state while initiating antiviral therapy. This patient was sexually active with both genders, and engaged in anoreceptive intercourse. STD tests were preformed and were negative, to include HIV PCR to exlude acute infection. Immunglobulin quantification testing was normal. Inflammatory bowel disease (IBD) also commonly presents in this age group with similar symptoms of colitis. CMV DNA has been demonstrated to be present in up to 66% of Crohn's disease biopsies; however, it did not correlate to disease activity. In ulcerative colitis, seropositive prevalence was 72% in one study, again without correlation to symptoms. A relationship between CMV and IBD has not been definitively demonstrated. Consideration should be made for delaying treatment in new cases of IBD until biopsies confirmation and exclusion of infection. Immunosuppressant therapy impairs host defenses, and glucocorticoid therapy has not conclusively been shown to improve outcomes in CMV colitis." @default.
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• W2977302839 date "2013-10-01" @default.
• W2977302839 modified "2023-09-24" @default.
• W2977302839 title "Crohnʼs Disease? Wait and CMV" @default.
• W2977302839 doi "https://doi.org/10.14309/00000434-201310001-01373" @default.
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