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P153. Reactivation of cytomegalovirus in inflammatory bowel disease - a 10 year case series

S. Fernandes1, L. Correia1, A. Rita Gonçalves1, A. Valente1, P. Moura Santos1, C. Baldaia1, N. Fatela1, P. Alexandrino1, M. Cortes2, J. Velosa1, 1Centro Hospitalar Lisboa Norte, Gastrenterology, Lisbon, Portugal, 2Centro Hospitalar Lisboa Norte, Internal Medicine, Lisbon, Portugal

Background

Cytomegalovirus (CMV) is responsible for severe infections in immunocompromised patients. Patients with inflammatory bowel disease (IBD) are frequently under immunosuppressive drugs and therefore at increased risk for CMV reactivation. The importance of this reactivation has not been established.

Methods

Hospital admissions between 2003 and 2013 were reviewed. Patients with IBD who reactivated CMV were selected.

Results

34 patients (17 male), mean age 48 years (15–80) with a previous diagnosis of Crohn's disease CD) (13) or Ulcerative Colitis (UC) (20) had reactivation of CMV. Most had extensive forms of disease (54% ileocolitis, 65% pancolitis) and moderate to severe activity (CDAI 288, Mayo 10). 85% were under at least one immunossupressive drug (56% steroids). Reactivation was diagnosed by histology (79%), serology (9%) and serum or intestinal polymerase chain reaction (36% and 9%). All received treatment with ganciclovir. 8 (24%) required surgery (7 UC), 2 following toxic megacolon. Average time till surgery 213 days (0–698). 3 patients died (2 CD). 8 patients (30%) suffered a second CMV reactivation with 2 requiring surgery.

Conclusion

Immunossupression inscreases the risk of reactivating CMV. In some cases of moderate to severe IBD CMV reactivation occurs, with high risk of complications. In our series antiviral therapy did not seem enough to halt the progression in severe forms of disease. Recurrence after treatment is common. Further controlled studies are needed to determine the actual contribution of CMV in acute exacerbations of IBD.