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P347. The efficacy of ganciclovir therapy in patients with steroid-refractory ulcerative colitis and cytomegalovirus infection

M.K. Choi1, G.A. Song1, D.U. Kim1, D.Y. Ryu1, 1Pusan National University College of Medicine, Internal Medicine, Busan, South Korea

Background

There are some reports that cytomegalovirus infection in patients with active ulcerative colitis is associated with poor clinical course. But, it is still difficult to assess the clinical impact of cytomegalovirus infection in patients with active ulcerative colitis and decide whether to treat the infection. Thus, we evaluated the effect of antiviral therapy against cytomegalovirus infection in patients with steroid-refractory ulcerative colitis, retrospectively.

Methods

71 patients with moderate-to-severe ulcerative colitis were admitted to our hospital for treatment with intravenous methylprednisolone between January 2007 and September 2012. After admission, diagnosis of cytomegalovirus infection was performed by a serologic test and/or a histopathologic examination using immunohistochemical staining. 14 patients without evaluation for cytomegalovirus infection were excluded from the study. All patients were initially treated with a high-dose methylprednisolone (40–60 mg/day) intravenously for 7–14 days.

Results

Of 57 patients enrolled, the presence of cytomegalovirus was identified in 18 patients (31.6%). 39 patients with moderate-to-severe ulcerative colitis including 7 patients with cytomegalovirus infection were responsive to initial steroid therapy. Of 18 patients with steroid-refractory ulcerative colitis, 11 patients had the cytomegalovirus infection and were treated with intravenous ganciclovir of 5 mg/kg twice a day for 2 to 3 weeks. Antiviral therapy showed a clear improvement in 10 patients. Only one patient with no response to ganciclovir treatment improved with infliximab subsequently. Of 7 patients who were steroid-refractory and had no evidence of cytomegalovirus infection, 3 patients had a delayed response to steroid therapy, 1 patient improved with infliximab, and 3 patients received ganciclovir therapy based on clinical suspicion of cytomegalovirus-induced colorectal ulcerations.

Conclusion

Before rescue medical therapy with cyclosporine or infliximab in patients with steroid-refractory ulcerative colitis, treatment for cytomegalovirus infection should be considered if cytomegalovirus infection was identified.