Abstract
A 21-year-old man was referred to our hospital early in May 2011 for treatment of relapsing ulcerative colitis. He had been diagnosed as having ulcerative colitis in June 2009 for the first time, whereafter his symptoms recurred. He had suffered from fever, diarrhea, and mucous bloody stool for a month, and had been treated using prednisolone, mesalazine, and azathioprine by his general practitioner in April 2011, however, his symptoms had not been reduced. Colonoscopy revealed rough mucosa and contact bleeding from the rectum to the ascending colon, but no ulceration was recognized. Treatment with 40-50 mg/day prednisolone, 4,000 mg/day mesalazine, and 50 mg/day azathioprine was not effective, and his symptoms became more severe thereafter. He was therefore admitted to our hospital late in May 2011. His symptoms weren’t improved despite of intensive care with leukocytapheresis and intravenous administration of an antibiotic agent in addition to the treatment mentioned above. Cytomegalovirus (CMV) pp65 antigen proved positive on the 1st hospital day. Based on that, he was diagnosed as having relapsing ulcerative colitis with CMV infection. Though ganciclovir (500 mg/day) was intravenously administered, no improvement of his symptoms was recognized, and colonoscopy revealed obvious ulceration at the transverse colon. Moreover, CMV pp65 antigen examined at the 10th hospital day became significantly worse. Pulse therapy using 1,000 mg prednisolone for 3 days and increasing of ganciclovir dose (750 mg/day) temporally reduced his symptoms for several days, but they got worse after that. From these clinical courses, we thought that the infected CMV was resistant to ganciclovir. Therefore, treatment with 9,000 mg/day foscarnet sodium hydrate and pulse therapy using 1,000 mg prednisolone for 3 days was performed. The high fever immediately disappeared, and the coditions of his diarrhea and mucous bloody stools improved. The levels of the CMV pp65 antigen showed a remarkable improvement. Remission of the ulcerative colitis was also successfully induced in this patient.
