Cytomegalovirus infection of the colon: a possible role in exacerbations of inflammatory bowel disease.

An exacerbation of idiopathic inflammatory bowel disease associated with the appearance of cytomegalovirus nuclear inclusion bodies in the colon was observed in two patients. In one, improvement in the colitis after withdrawal of corticosteroids suggested cytomegalovirus as the cause of the exacerbation. A review of the 16 reported cases of inflammatory bowel disease with cytomegalovirus superinfection of the colon indicates a high mortality rate (seven of 16), a frequent association with toxic dilatation of the colon, and a clinical course sufficiently severe to require colectomy in 10 of 16 patients. For exacerbations of inflammatory bowel disease associated with evidence of cytomegalovirus infection of the colon which are refractory to medical management withdrawal of corticosteroids and other immunosuppressive therapy should be considered. If necessary, early colectomy may be an appropriate alternative.