BACKGROUND: Up to 30% of cases of pouchitis are felt to have a secondary cause. Cytomegalovirus (CMV) may represent a possible etiopathological agent. Here, we report our experience with CMV involvement of the pouch, including risk factors, clinical features, and pouch outcomes in patients with inflammatory bowel disease after proctocolectomy with ileal pouch-anal anastomosis. METHODS: The pathology database at Mayo Clinic in Rochester was searched between January 1995 and October 2012 for patients with a tissue diagnosis of CMV of the pouch following ileal pouch-anal anastomosis. RESULTS: Seven patients with CMV inclusions of the pouch were identified. The median age was 35 (range, 10-53) years, and the majority were female (71%). Five patients (71%) were on immunosuppressive medications including 4 who had undergone orthotopic liver transplantation for primary sclerosing cholangitis. The clinical presentation was similar among all patients: the majority had diarrhea (86%), fever (71%), and abdominal pain (57%). All had mucosal inflammation, with 71% having focal ulcerations in the pouch and 60% having inflammatory changes in the prepouch ileum. All patients improved with ganciclovir. None required pouch excision or had recurrent CMV infection. Three patients had recurrent nonspecific pouchitis. CONCLUSIONS: A high index of suspicion is needed to diagnose CMV of the pouch. An increase in stool frequency and fever in patients on immune suppression or in those who have failed empiric antibiotics should prompt assessment for CMV infection. Antiviral therapy seems to be effective, and postinfection pouch outcomes seem favorable, particularly in those presenting with their first episode of pouchitis.
BACKGROUND: Up to 30% of cases of pouchitis are felt to have a secondary cause. Cytomegalovirus (CMV) may represent a possible etiopathological agent. Here, we report our experience with CMV involvement of the pouch, including risk factors, clinical features, and pouch outcomes in patients with inflammatory bowel disease after proctocolectomy with ileal pouch-anal anastomosis. METHODS: The pathology database at Mayo Clinic in Rochester was searched between January 1995 and October 2012 for patients with a tissue diagnosis of CMV of the pouch following ileal pouch-anal anastomosis. RESULTS: Seven patients with CMV inclusions of the pouch were identified. The median age was 35 (range, 10-53) years, and the majority were female (71%). Five patients (71%) were on immunosuppressive medications including 4 who had undergone orthotopic liver transplantation for primary sclerosing cholangitis. The clinical presentation was similar among all patients: the majority had diarrhea (86%), fever (71%), and abdominal pain (57%). All had mucosal inflammation, with 71% having focal ulcerations in the pouch and 60% having inflammatory changes in the prepouch ileum. All patients improved with ganciclovir. None required pouch excision or had recurrent CMV infection. Three patients had recurrent nonspecific pouchitis. CONCLUSIONS: A high index of suspicion is needed to diagnose CMV of the pouch. An increase in stool frequency and fever in patients on immune suppression or in those who have failed empiric antibiotics should prompt assessment for CMV infection. Antiviral therapy seems to be effective, and postinfection pouch outcomes seem favorable, particularly in those presenting with their first episode of pouchitis.
Authors: P Gionchetti; F Rizzello; A Venturi; P Brigidi; D Matteuzzi; G Bazzocchi; G Poggioli; M Miglioli; M Campieri Journal: Gastroenterology Date: 2000-08 Impact factor: 22.682
Authors: K A Papadakis; J K Tung; S W Binder; L Y Kam; M T Abreu; S R Targan; E A Vasiliauskas Journal: Am J Gastroenterol Date: 2001-07 Impact factor: 10.864
Authors: Willem E Hueting; Erik Buskens; Ingeborg van der Tweel; Hein G Gooszen; Cees J H M van Laarhoven Journal: Dig Surg Date: 2005-04-14 Impact factor: 2.588
Authors: Victor Warren Fazio; Ravi P Kiran; Feza H Remzi; John Calvin Coffey; Helen Mary Heneghan; Hasan Tarik Kirat; Elena Manilich; Bo Shen; Sean T Martin Journal: Ann Surg Date: 2013-04 Impact factor: 12.969
Authors: R F Leal; C S R Coy; M L S Ayrizono; J J Fagundes; M Milanski; M J Saad; L A Velloso; J R N Góes Journal: Tech Coloproctol Date: 2008-05-30 Impact factor: 3.781
Authors: Eirini Mavropoulou; Kristin Ternes; Nicolae-Catalin Mechie; Sebastian Christopher Benjamin Bremer; Steffen Kunsch; Volker Ellenrieder; Albrecht Neesse; Ahmad Amanzada Journal: BMJ Open Gastroenterol Date: 2019-02-27
Authors: Christian Rupp; Esther Herpel; Paul Schnitzler; Anna Zawierucha; Philipp Zwickel; Lukas Klute; Martina Kadmon; Wolfgang Stremmel; Annika Gauss Journal: J Med Case Rep Date: 2014-05-26