Outcome of cytomegalovirus infections in patients with inflammatory bowel disease

Konstantinos Papadakis, Jim K. Tung, Scott W. Binder, Lori Y. Kam, Maria T. Abreu, Stephan R. Targan, Eric A. Vasiliauskas

Research output: Contribution to journalArticle

218 Citations (Scopus)

Abstract

OBJECTIVE: The aim of this study was to determine the outcome of cytomegalovirus (CMV) infections complicating the course of inflammatory bowel disease (IBD). METHODS: The records and clinical courses were reviewed for all IBD patients who were evaluated at the IBD Center of the Cedars-Sinai Medical Center and who developed CMV infection. RESULTS: Ten patients with severe, medically refractory IBD (five ulcerative colitis, three Crohn's colitis, and two indeterminate colitis) developed CMV infection. All but two were hospitalized with exacerbation of their underlying disease and were receiving immunosuppressive treatment with steroids, thiopurines, and/or cyclosporine at the time CMV infection was recognized. Eight patients had documented colonic CMV (one had concurrent upper GI tract involvement), one developed interstitial CMV and Pneumocystis carinii pneumonia, and one developed primary CMV mononucleosis. Prompt treatment with ganciclovir and withdrawal of immunosuppressive treatment resulted in gradual improvement and induction of remission of the underlying IBD in five patients. The patient with concomitant CMV and P. carinii pneumonitis died. In two patients, treatment with ganciclovir did not alter the clinical course of their IBD, and one of them underwent colectomy. In one patient CMV was found on the resected colonic specimen. One patient with primary CMV infection responded also to ganciclovir treatment. CONCLUSIONS: CMV infection may aggravate the course of seemingly refractory IBD in patients who either fail to respond or experience worsening of symptoms despite immunosuppressive therapy. Expedient evaluation, prompt treatment intervention with ganciclovir, and withdrawal of immunosuppressive treatment may avoid complications and mortality. This regimen leads to improvement of the underlying IBD in most patients.

Original languageEnglish (US)
Pages (from-to)2137-2142
Number of pages6
JournalAmerican Journal of Gastroenterology
Volume96
Issue number7
DOIs
StatePublished - Jan 1 2001
Externally publishedYes

Fingerprint

Cytomegalovirus Infections
Inflammatory Bowel Diseases
Cytomegalovirus
Ganciclovir
Immunosuppressive Agents
Colitis
Therapeutics
Pneumocystis carinii
Remission Induction
Upper Gastrointestinal Tract
Pneumocystis Pneumonia
Colectomy
Ulcerative Colitis
Cyclosporine
Pneumonia
Steroids
Mortality

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

Papadakis, K., Tung, J. K., Binder, S. W., Kam, L. Y., Abreu, M. T., Targan, S. R., & Vasiliauskas, E. A. (2001). Outcome of cytomegalovirus infections in patients with inflammatory bowel disease. American Journal of Gastroenterology, 96(7), 2137-2142. https://doi.org/10.1016/S0002-9270(01)02512-6

Outcome of cytomegalovirus infections in patients with inflammatory bowel disease. / Papadakis, Konstantinos; Tung, Jim K.; Binder, Scott W.; Kam, Lori Y.; Abreu, Maria T.; Targan, Stephan R.; Vasiliauskas, Eric A.

In: American Journal of Gastroenterology, Vol. 96, No. 7, 01.01.2001, p. 2137-2142.

Research output: Contribution to journalArticle

Papadakis, K, Tung, JK, Binder, SW, Kam, LY, Abreu, MT, Targan, SR & Vasiliauskas, EA 2001, 'Outcome of cytomegalovirus infections in patients with inflammatory bowel disease', American Journal of Gastroenterology, vol. 96, no. 7, pp. 2137-2142. https://doi.org/10.1016/S0002-9270(01)02512-6
Papadakis, Konstantinos ; Tung, Jim K. ; Binder, Scott W. ; Kam, Lori Y. ; Abreu, Maria T. ; Targan, Stephan R. ; Vasiliauskas, Eric A. / Outcome of cytomegalovirus infections in patients with inflammatory bowel disease. In: American Journal of Gastroenterology. 2001 ; Vol. 96, No. 7. pp. 2137-2142.
@article{88008e2493d347ff969a60c0565e6ca6,
title = "Outcome of cytomegalovirus infections in patients with inflammatory bowel disease",
abstract = "OBJECTIVE: The aim of this study was to determine the outcome of cytomegalovirus (CMV) infections complicating the course of inflammatory bowel disease (IBD). METHODS: The records and clinical courses were reviewed for all IBD patients who were evaluated at the IBD Center of the Cedars-Sinai Medical Center and who developed CMV infection. RESULTS: Ten patients with severe, medically refractory IBD (five ulcerative colitis, three Crohn's colitis, and two indeterminate colitis) developed CMV infection. All but two were hospitalized with exacerbation of their underlying disease and were receiving immunosuppressive treatment with steroids, thiopurines, and/or cyclosporine at the time CMV infection was recognized. Eight patients had documented colonic CMV (one had concurrent upper GI tract involvement), one developed interstitial CMV and Pneumocystis carinii pneumonia, and one developed primary CMV mononucleosis. Prompt treatment with ganciclovir and withdrawal of immunosuppressive treatment resulted in gradual improvement and induction of remission of the underlying IBD in five patients. The patient with concomitant CMV and P. carinii pneumonitis died. In two patients, treatment with ganciclovir did not alter the clinical course of their IBD, and one of them underwent colectomy. In one patient CMV was found on the resected colonic specimen. One patient with primary CMV infection responded also to ganciclovir treatment. CONCLUSIONS: CMV infection may aggravate the course of seemingly refractory IBD in patients who either fail to respond or experience worsening of symptoms despite immunosuppressive therapy. Expedient evaluation, prompt treatment intervention with ganciclovir, and withdrawal of immunosuppressive treatment may avoid complications and mortality. This regimen leads to improvement of the underlying IBD in most patients.",
author = "Konstantinos Papadakis and Tung, {Jim K.} and Binder, {Scott W.} and Kam, {Lori Y.} and Abreu, {Maria T.} and Targan, {Stephan R.} and Vasiliauskas, {Eric A.}",
year = "2001",
month = "1",
day = "1",
doi = "10.1016/S0002-9270(01)02512-6",
language = "English (US)",
volume = "96",
pages = "2137--2142",
journal = "American Journal of Gastroenterology",
issn = "0002-9270",
publisher = "Nature Publishing Group",
number = "7",

}

TY - JOUR

T1 - Outcome of cytomegalovirus infections in patients with inflammatory bowel disease

AU - Papadakis, Konstantinos

AU - Tung, Jim K.

AU - Binder, Scott W.

AU - Kam, Lori Y.

AU - Abreu, Maria T.

AU - Targan, Stephan R.

AU - Vasiliauskas, Eric A.

PY - 2001/1/1

Y1 - 2001/1/1

N2 - OBJECTIVE: The aim of this study was to determine the outcome of cytomegalovirus (CMV) infections complicating the course of inflammatory bowel disease (IBD). METHODS: The records and clinical courses were reviewed for all IBD patients who were evaluated at the IBD Center of the Cedars-Sinai Medical Center and who developed CMV infection. RESULTS: Ten patients with severe, medically refractory IBD (five ulcerative colitis, three Crohn's colitis, and two indeterminate colitis) developed CMV infection. All but two were hospitalized with exacerbation of their underlying disease and were receiving immunosuppressive treatment with steroids, thiopurines, and/or cyclosporine at the time CMV infection was recognized. Eight patients had documented colonic CMV (one had concurrent upper GI tract involvement), one developed interstitial CMV and Pneumocystis carinii pneumonia, and one developed primary CMV mononucleosis. Prompt treatment with ganciclovir and withdrawal of immunosuppressive treatment resulted in gradual improvement and induction of remission of the underlying IBD in five patients. The patient with concomitant CMV and P. carinii pneumonitis died. In two patients, treatment with ganciclovir did not alter the clinical course of their IBD, and one of them underwent colectomy. In one patient CMV was found on the resected colonic specimen. One patient with primary CMV infection responded also to ganciclovir treatment. CONCLUSIONS: CMV infection may aggravate the course of seemingly refractory IBD in patients who either fail to respond or experience worsening of symptoms despite immunosuppressive therapy. Expedient evaluation, prompt treatment intervention with ganciclovir, and withdrawal of immunosuppressive treatment may avoid complications and mortality. This regimen leads to improvement of the underlying IBD in most patients.

AB - OBJECTIVE: The aim of this study was to determine the outcome of cytomegalovirus (CMV) infections complicating the course of inflammatory bowel disease (IBD). METHODS: The records and clinical courses were reviewed for all IBD patients who were evaluated at the IBD Center of the Cedars-Sinai Medical Center and who developed CMV infection. RESULTS: Ten patients with severe, medically refractory IBD (five ulcerative colitis, three Crohn's colitis, and two indeterminate colitis) developed CMV infection. All but two were hospitalized with exacerbation of their underlying disease and were receiving immunosuppressive treatment with steroids, thiopurines, and/or cyclosporine at the time CMV infection was recognized. Eight patients had documented colonic CMV (one had concurrent upper GI tract involvement), one developed interstitial CMV and Pneumocystis carinii pneumonia, and one developed primary CMV mononucleosis. Prompt treatment with ganciclovir and withdrawal of immunosuppressive treatment resulted in gradual improvement and induction of remission of the underlying IBD in five patients. The patient with concomitant CMV and P. carinii pneumonitis died. In two patients, treatment with ganciclovir did not alter the clinical course of their IBD, and one of them underwent colectomy. In one patient CMV was found on the resected colonic specimen. One patient with primary CMV infection responded also to ganciclovir treatment. CONCLUSIONS: CMV infection may aggravate the course of seemingly refractory IBD in patients who either fail to respond or experience worsening of symptoms despite immunosuppressive therapy. Expedient evaluation, prompt treatment intervention with ganciclovir, and withdrawal of immunosuppressive treatment may avoid complications and mortality. This regimen leads to improvement of the underlying IBD in most patients.

UR - http://www.scopus.com/inward/record.url?scp=0034936972&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0034936972&partnerID=8YFLogxK

U2 - 10.1016/S0002-9270(01)02512-6

DO - 10.1016/S0002-9270(01)02512-6

M3 - Article

C2 - 11467645

AN - SCOPUS:0034936972

VL - 96

SP - 2137

EP - 2142

JO - American Journal of Gastroenterology

JF - American Journal of Gastroenterology

SN - 0002-9270

IS - 7

ER -