GASTROENTEROLOGY ARTICLE OF THE WEEK
February 15, 2007
Kandiel A, Lashner B. Cytomegalovirus Colitis Complicating Inflammatory Bowel Disease. Am J Gastroenterol 2006;101:2857-2865
1. CMV colitis in the presence of IBD
a. May affect the right colon exclusively in up to 30% of patients
b. Biopsing the edge of the ulcer increases the yield
c. CMV infection almost always causes deep colonic ulcers
d. CMV superimposed on IBD creates a typical endoscopic picture
e. immunohistochemical stains are more sensitive than routine histologic examination of biopsy tissue
2. A 48 year old man with CMV colitis superimposed on ulcerative pancolitis, who has a creatinine of 2.8 secondary to hypertensive nephropathy should be treated with:
a. Foscarnet 90mg/kg IV bid
b. Valganciclovir three times a day for 6 weeks
c. Ganciclovir 5mg/kg IV bid
d. Cyclosporine 5mg/kg bid
e. Acyclovir 10mg/kg IV bid
True or False
3. A patient with a blood CMV PCR count of 1,200 has CMV disease
4. Symptomatic CMV colitis does not occur in an immunecompetent host
5. The presence of CMV in colonic histologic material is an absolute contraindications to corticosteroid therapy
6. Latent CMV infection may be reactivated by elevated levels of TNF alpha and IFN gamma often seen in active colitis
7. CMV is found in over 50% of IBD patients with severe steroid-refractory disease
8. The most common dose limiting side effect of ganciclovir is myelotoxicity
9. Serum levels that suggest the presence of CMV disease are CMV DNA levels of over 5,000 copies/ml in plasma or over 25,000 copies/ml in whole blood