Cytomegalovirus Infection in a Patient With Steroid-Resistant Ulcerative Colitis

Abstract

A 56-year-old Japanese man with ulcerative colitis was admitted because of being judged as resistance to treatment with intravenous prednisolone (60-100 mg/day) and oral sulfasalazine (3 g/day) over 1.5 months at another hospital. Colonoscopy at our hospital showed multiple punched-out ulcers from the cecum to the descending colon without active inflammation in the rectum. Although cytomegalovirus superinfection after long-term steroid administration was highly suspected and the treatment for it was planned, he developed massive bleeding and progressive clinical deterioration that necessitated emergency total colectomy in several days after the colonoscopic examination. Histopathologically, cytomegalic inclusion bodies were identified on the ulcer rim and base, while the activity of ulcerative colitis was kept under control with steroid. Because the antigenemia of cytomegalovirus continued positive even after colectomy, ganciclovir was administered until the antigenemia was turned into negative. The present case showed that cytomegalovirus superinfection should be considered in patients with inflammatory bowel disease having long-term steroid administration and immediate serological and histological investigation should be performed when the clinical course is unusual.