Cytomegalovirus Infection in Ulcerative Colitis: An Ambispective Study from a Single Center

Abstract

Abstract Background and Objectives Cytomegalovirus (CMV) is often detected in colonic tissue of patients with inflammatory bowel disease. Its role as a “bystander” or “culprit” in ulcerative colitis (UC) flares is unclear. The aim of the study is to detect the prevalence and outcomes of CMV infection in UC Materials and Methods All adult patients (both retrospective and prospective), diagnosed with UC in a tertiary care center, were included. Patients underwent colonic biopsies for histopathological examination for CMV. CMV immunoglobulin G (IgG) was also tested to ascertain seroprevalence in this population. CMV infection was defined as presence of CMV inclusions in histopathology. Treatment outcomes were defined as remission, clinical improvement, and partial response. The number of flares and outcomes of disease activity in terms of flare of disease, hospitalization, need of colectomy, and mortality was noted at follow-up. Results A total of 58 patients of UC were included (mean age was 37.3 years, males—66%). Serum CMV IgG was positive in all patients. Twelve patients (20.6%, 9 males) with active UC were found to have CMV infection in histopathology specimens with hematoxylin and eosin staining. Two-third of patients (8/12) had severe disease, while the remaining (4/12) had moderate disease activity. Nine patients (9/12) with CMV colitis achieved complete remission with standard treatment without antiviral therapy. Of the three patients who needed antiviral therapy, two underwent colectomy in follow-up. CMV-positive patients to be predominantly male (p = 0.58) had more frequent relapses (p = 0.08) and were hospitalized for their flares (p = 0.06) when compared with CMV-negative patients. None of these factors were found to be statistically significant. Conclusion CMV infection was found in one-fifth of patients of UC with flare. All patients with CMV infection had moderate-to-severe disease. Majority achieved remission without the need of antiviral therapy.