Characteristics and Clinical Implications of Cytomegalovirus Infection in Patients with Drug-Resistant Ulcerative Colitis Undergoing Colectomy-Data from a Tertiary Referral Center in Poland

Abstract

Background/Objectives: This study aimed to assess the frequency, risk factors, and clinical implications of cytomegalovirus (CMV) colitis in patients undergoing colectomy due to refractory ulcerative colitis (UC). Methods: A retrospective analysis was conducted on patients with drug-resistant UC who underwent colectomy at a tertiary referral center between 2009 and 2017. Histological inflammatory activity in surgical specimens was assessed using the Simplified Geboes Score. The presence and density of CMV expression were estimated immunohistochemically. Preoperative clinical, biochemical, and endoscopic data, as well as the short- and long-term postoperative disease courses, were evaluated in relation to the presence of CMV colitis at the time of surgery. Results: CMV colitis was identified in 14% (7/49) of patients. The CMV-positive group exhibited significantly shorter disease durations and higher C-reactive protein concentrations at the time of surgery. This subgroup also demonstrated consistently numerically higher steroid use, both in terms of the usage frequency and cumulative treatment duration. Patients with concomitant CMV colitis had lower likelihoods of stoma closure and restoration of gastrointestinal continuity in the long-term. Conclusions: Concomitant CMV colitis is not uncommon in patients with treatment-refractory UC. Testing for CMV should be considered, particularly in individuals with a short-term, dynamic, and aggressive disease course unresponsive to standard therapy, especially steroids.

Keywords: colectomy; cytomegalovirus; immunohistochemistry; ulcerative colitis.

Figure 1

Immunohistochemical expression of cytomegalovirus in a surgical specimen from a patient with ulcerative colitis (magnification: 200×).