Cytomegalovirus infection of the ileoanal pouch: Clinical characteristics and outcomes

Jeffrey D. McCurdy, Edward Vincent Loftus, Jr, William J. Tremaine, Thomas Christopher Smyrk, David H. Bruining, Darrell S. Pardi, Laura E. H. Raffals, John B Kisiel, Nayantara Coelho-Prabhu, Sunanda V. Kane, William Alvis Faubion, Konstantinos Papadakis

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background: Up to 30% of cases of pouchitis are felt to have a secondary cause. Cytomegalovirus (CMV) may represent a possible etiopathological agent. Here, we report our experience with CMV involvement of the pouch, including risk factors, clinical features, and pouch outcomes in patients with inflammatory bowel disease after proctocolectomy with ileal pouch anal anastomosis. Methods: The pathology database at Mayo Clinic in Rochester was searched between January 1995 and October 2012 for patients with a tissue diagnosis of CMV of the pouch following ileal pouch anal anastomosis. Results: Seven patients with CMV inclusions of the pouch were identified. The median age was 35 (range, 1053) years, and the majority were female (71%). Five patients (71%) were on immunosuppressive medications including 4 who had undergone orthotopic liver transplantation for primary sclerosing cholangitis. The clinical presentation was similar among all patients: the majority had diarrhea (86%), fever (71%), and abdominal pain (57%). All had mucosal inflammation, with 71% having focal ulcerations in the pouch and 60% having inflammatory changes in the prepouch ileum. All patients improved with ganciclovir. None required pouch excision or had recurrent CMV infection. Three patients had recurrent nonspecific pouchitis. Conclusions: A high index of suspicion is needed to diagnose CMV of the pouch. An increase in stool frequency and fever in patients on immune suppression or in those who have failed empiric antibiotics should prompt assessment for CMV infection. Antiviral therapy seems to be effective, and postinfection pouch outcomes seem favorable, particularly in those presenting with their first episode of pouchitis.

Original languageEnglish (US)
Pages (from-to)2394-2399
Number of pages6
JournalInflammatory Bowel Diseases
Volume19
Issue number11
DOIs
StatePublished - Oct 2013

Fingerprint

Colonic Pouches
Cytomegalovirus Infections
Cytomegalovirus
Pouchitis
Fever
Sclerosing Cholangitis
Ganciclovir
Immunosuppressive Agents
Ileum
Inflammatory Bowel Diseases
Liver Transplantation
Abdominal Pain
Antiviral Agents
Diarrhea
Databases
Pathology
Anti-Bacterial Agents
Inflammation

Keywords

  • Cytomegalovirus
  • Ileal pouch anal anastomosis
  • Pouchitis

ASJC Scopus subject areas

  • Gastroenterology
  • Immunology and Allergy

Cite this

Cytomegalovirus infection of the ileoanal pouch : Clinical characteristics and outcomes. / McCurdy, Jeffrey D.; Loftus, Jr, Edward Vincent; Tremaine, William J.; Smyrk, Thomas Christopher; Bruining, David H.; Pardi, Darrell S.; Raffals, Laura E. H.; Kisiel, John B; Coelho-Prabhu, Nayantara; Kane, Sunanda V.; Faubion, William Alvis; Papadakis, Konstantinos.

In: Inflammatory Bowel Diseases, Vol. 19, No. 11, 10.2013, p. 2394-2399.

Research output: Contribution to journalArticle

McCurdy, Jeffrey D. ; Loftus, Jr, Edward Vincent ; Tremaine, William J. ; Smyrk, Thomas Christopher ; Bruining, David H. ; Pardi, Darrell S. ; Raffals, Laura E. H. ; Kisiel, John B ; Coelho-Prabhu, Nayantara ; Kane, Sunanda V. ; Faubion, William Alvis ; Papadakis, Konstantinos. / Cytomegalovirus infection of the ileoanal pouch : Clinical characteristics and outcomes. In: Inflammatory Bowel Diseases. 2013 ; Vol. 19, No. 11. pp. 2394-2399.
@article{af9c113e70054a2f8094fa0e87458601,
title = "Cytomegalovirus infection of the ileoanal pouch: Clinical characteristics and outcomes",
abstract = "Background: Up to 30{\%} of cases of pouchitis are felt to have a secondary cause. Cytomegalovirus (CMV) may represent a possible etiopathological agent. Here, we report our experience with CMV involvement of the pouch, including risk factors, clinical features, and pouch outcomes in patients with inflammatory bowel disease after proctocolectomy with ileal pouch anal anastomosis. Methods: The pathology database at Mayo Clinic in Rochester was searched between January 1995 and October 2012 for patients with a tissue diagnosis of CMV of the pouch following ileal pouch anal anastomosis. Results: Seven patients with CMV inclusions of the pouch were identified. The median age was 35 (range, 1053) years, and the majority were female (71{\%}). Five patients (71{\%}) were on immunosuppressive medications including 4 who had undergone orthotopic liver transplantation for primary sclerosing cholangitis. The clinical presentation was similar among all patients: the majority had diarrhea (86{\%}), fever (71{\%}), and abdominal pain (57{\%}). All had mucosal inflammation, with 71{\%} having focal ulcerations in the pouch and 60{\%} having inflammatory changes in the prepouch ileum. All patients improved with ganciclovir. None required pouch excision or had recurrent CMV infection. Three patients had recurrent nonspecific pouchitis. Conclusions: A high index of suspicion is needed to diagnose CMV of the pouch. An increase in stool frequency and fever in patients on immune suppression or in those who have failed empiric antibiotics should prompt assessment for CMV infection. Antiviral therapy seems to be effective, and postinfection pouch outcomes seem favorable, particularly in those presenting with their first episode of pouchitis.",
keywords = "Cytomegalovirus, Ileal pouch anal anastomosis, Pouchitis",
author = "McCurdy, {Jeffrey D.} and {Loftus, Jr}, {Edward Vincent} and Tremaine, {William J.} and Smyrk, {Thomas Christopher} and Bruining, {David H.} and Pardi, {Darrell S.} and Raffals, {Laura E. H.} and Kisiel, {John B} and Nayantara Coelho-Prabhu and Kane, {Sunanda V.} and Faubion, {William Alvis} and Konstantinos Papadakis",
year = "2013",
month = "10",
doi = "10.1097/MIB.0b013e3182a52553",
language = "English (US)",
volume = "19",
pages = "2394--2399",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "John Wiley and Sons Inc.",
number = "11",

}

TY - JOUR

T1 - Cytomegalovirus infection of the ileoanal pouch

T2 - Clinical characteristics and outcomes

AU - McCurdy, Jeffrey D.

AU - Loftus, Jr, Edward Vincent

AU - Tremaine, William J.

AU - Smyrk, Thomas Christopher

AU - Bruining, David H.

AU - Pardi, Darrell S.

AU - Raffals, Laura E. H.

AU - Kisiel, John B

AU - Coelho-Prabhu, Nayantara

AU - Kane, Sunanda V.

AU - Faubion, William Alvis

AU - Papadakis, Konstantinos

PY - 2013/10

Y1 - 2013/10

N2 - Background: Up to 30% of cases of pouchitis are felt to have a secondary cause. Cytomegalovirus (CMV) may represent a possible etiopathological agent. Here, we report our experience with CMV involvement of the pouch, including risk factors, clinical features, and pouch outcomes in patients with inflammatory bowel disease after proctocolectomy with ileal pouch anal anastomosis. Methods: The pathology database at Mayo Clinic in Rochester was searched between January 1995 and October 2012 for patients with a tissue diagnosis of CMV of the pouch following ileal pouch anal anastomosis. Results: Seven patients with CMV inclusions of the pouch were identified. The median age was 35 (range, 1053) years, and the majority were female (71%). Five patients (71%) were on immunosuppressive medications including 4 who had undergone orthotopic liver transplantation for primary sclerosing cholangitis. The clinical presentation was similar among all patients: the majority had diarrhea (86%), fever (71%), and abdominal pain (57%). All had mucosal inflammation, with 71% having focal ulcerations in the pouch and 60% having inflammatory changes in the prepouch ileum. All patients improved with ganciclovir. None required pouch excision or had recurrent CMV infection. Three patients had recurrent nonspecific pouchitis. Conclusions: A high index of suspicion is needed to diagnose CMV of the pouch. An increase in stool frequency and fever in patients on immune suppression or in those who have failed empiric antibiotics should prompt assessment for CMV infection. Antiviral therapy seems to be effective, and postinfection pouch outcomes seem favorable, particularly in those presenting with their first episode of pouchitis.

AB - Background: Up to 30% of cases of pouchitis are felt to have a secondary cause. Cytomegalovirus (CMV) may represent a possible etiopathological agent. Here, we report our experience with CMV involvement of the pouch, including risk factors, clinical features, and pouch outcomes in patients with inflammatory bowel disease after proctocolectomy with ileal pouch anal anastomosis. Methods: The pathology database at Mayo Clinic in Rochester was searched between January 1995 and October 2012 for patients with a tissue diagnosis of CMV of the pouch following ileal pouch anal anastomosis. Results: Seven patients with CMV inclusions of the pouch were identified. The median age was 35 (range, 1053) years, and the majority were female (71%). Five patients (71%) were on immunosuppressive medications including 4 who had undergone orthotopic liver transplantation for primary sclerosing cholangitis. The clinical presentation was similar among all patients: the majority had diarrhea (86%), fever (71%), and abdominal pain (57%). All had mucosal inflammation, with 71% having focal ulcerations in the pouch and 60% having inflammatory changes in the prepouch ileum. All patients improved with ganciclovir. None required pouch excision or had recurrent CMV infection. Three patients had recurrent nonspecific pouchitis. Conclusions: A high index of suspicion is needed to diagnose CMV of the pouch. An increase in stool frequency and fever in patients on immune suppression or in those who have failed empiric antibiotics should prompt assessment for CMV infection. Antiviral therapy seems to be effective, and postinfection pouch outcomes seem favorable, particularly in those presenting with their first episode of pouchitis.

KW - Cytomegalovirus

KW - Ileal pouch anal anastomosis

KW - Pouchitis

UR - http://www.scopus.com/inward/record.url?scp=84888255636&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84888255636&partnerID=8YFLogxK

U2 - 10.1097/MIB.0b013e3182a52553

DO - 10.1097/MIB.0b013e3182a52553

M3 - Article

C2 - 23974995

AN - SCOPUS:84888255636

VL - 19

SP - 2394

EP - 2399

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 11

ER -