INTRODUCTION: The first presentation of ulcerative colitis may be an acute flare in about 15% of patients, requiring hospital admission. In acute severe steroid-refractory ulcerative colitis, cytomegalovirus (CMV) should be sought because it is a frequent cause of refractory disease. Herpes simplex colitis constitutes a rarer event in ulcerative colitis patients and it is usually associated with immunosuppression. CASE PRESENTATION: We report a case of a first presentation of ulcerative colitis complicated by CMV and herpes simplex type 2 coinfection. After a long period of systemic corticosteroids, the diagnosis of both CMV and herpes colitis was made. Despite antiviral treatment, colectomy was required due to a contained perforation. DISCUSSION/ CONCLUSION: This report highlights the importance of a high degree of suspicion for opportunistic infections in steroid/immunomodulator refractory ulcerative colitis, even in the first flare.
INTRODUCTION: The first presentation of ulcerative colitis may be an acute flare in about 15% of patients, requiring hospital admission. In acute severe steroid-refractory ulcerative colitis, cytomegalovirus (CMV) should be sought because it is a frequent cause of refractory disease. Herpes simplex colitis constitutes a rarer event in ulcerative colitis patients and it is usually associated with immunosuppression. CASE PRESENTATION: We report a case of a first presentation of ulcerative colitis complicated by CMV and herpes simplex type 2 coinfection. After a long period of systemic corticosteroids, the diagnosis of both CMV and herpes colitis was made. Despite antiviral treatment, colectomy was required due to a contained perforation. DISCUSSION/ CONCLUSION: This report highlights the importance of a high degree of suspicion for opportunistic infections in steroid/immunomodulator refractory ulcerative colitis, even in the first flare.
Authors: J F Rahier; F Magro; C Abreu; A Armuzzi; S Ben-Horin; Y Chowers; M Cottone; L de Ridder; G Doherty; R Ehehalt; M Esteve; K Katsanos; C W Lees; E Macmahon; T Moreels; W Reinisch; H Tilg; L Tremblay; G Veereman-Wauters; N Viget; Y Yazdanpanah; R Eliakim; J F Colombel Journal: J Crohns Colitis Date: 2014-03-06 Impact factor: 9.071
Authors: Murat Toruner; Edward V Loftus; W Scott Harmsen; Alan R Zinsmeister; Robert Orenstein; William J Sandborn; Jean-Frederic Colombel; Laurence J Egan Journal: Gastroenterology Date: 2008-01-11 Impact factor: 22.682
Authors: Fernando Magro; Paolo Gionchetti; Rami Eliakim; Sandro Ardizzone; Alessandro Armuzzi; Manuel Barreiro-de Acosta; Johan Burisch; Krisztina B Gecse; Ailsa L Hart; Pieter Hindryckx; Cord Langner; Jimmy K Limdi; Gianluca Pellino; Edyta Zagórowicz; Tim Raine; Marcus Harbord; Florian Rieder Journal: J Crohns Colitis Date: 2017-06-01 Impact factor: 10.020