Cytomegalovirus Colitis in Adult Patients with Inflammatory Bowel Disease

Abstract

Cytomegalovirus (CMV) colitis, a complication in patients with inflammatory bowel disease (IBD), particularly ulcerative colitis (UC), is a significant diagnostic and therapeutic challenge due to its overlap with IBD flares. CMV reactivation in IBD is driven by chronic inflammation, compromised immune function, and use of immunosuppressive agents like corticosteroids. Risk factors include older age, pancolitis, and severe disease. Diagnosis hinges on endoscopy and histology, with tissue biopsy and immunohistochemistry as the gold standard. Quantitative tissue PCR may aid in differentiating latent from active infection. CMV colitis exacerbates IBD symptoms, prolongs hospitalization, and increases colectomy rates. Antiviral therapy, primarily ganciclovir, improves outcomes in patients with corticosteroid-refractory UC. Treatment focuses on tapering corticosteroids, optimizing biologic therapies such as infliximab, and a careful application of antivirals tailored to disease severity and viral load. Further research is needed to refine diagnostic thresholds and treatment strategies to mitigate CMV's impact on IBD prognosis. Early identification and individualized management are critical to improving clinical outcomes and reducing morbidity.

Keywords: colitis; cytomegalovirus; inflammatory bowel disease.

Figure 1

Colonoscopy image showing mucosal ulceration of the distal rectum in CMV colitis in an immunocompetent patient [36].

Figure 2

CMV-infected (a) mesenchymal cells from colonic tissue; (b) endothelial cells from colonic tissue. These CMV-infected cells have large ovoid nuclei with basophilic intranuclear inclusions (Cowdry bodies) surrounded by a clear halo (arrows) [37].

Figure 3

H&E stain of rectal biopsy, showing a large nucleus (arrow) with a smudged, eosinophilic chromatin pattern consistent with cytomegalovirus colitis [36].

Figure 4

Diagnostic approach for CMV colitis.

Figure 5

Treatment approach for CMV colitis.