valganciclovir and Ulcer

Topics: AIDS-Related Opportunistic Infections; Anti-HIV Agents; Anus Diseases; Biopsy; Cytomegalovirus Infections; Ganciclovir; HIV Infections; Humans; Immunocompromised Host; Male; Middle Aged; Treatment Outcome; Ulcer; Valganciclovir

Colectomy with ileoanal pouch formation is usually contraindicated in patients with Crohn's disease (CD) due to the risk of recurrent disease and pouch failure. We report the case of a patient, initially thought to have ulcerative colitis (UC), who underwent such surgery but subsequently developed perianal CD. She presented with diarrhoea and weight loss. Inflammatory markers were raised. Pouchoscopy revealed deep ulcers within the pouch. The main differential diagnoses were idiopathic pouchitis and recurrent CD. However, immunohistochemical staining demonstrated positivity for cytomegalovirus (CMV). Stool frequency, C reactive protein and albumin normalised within 48 h of starting oral valgancyclovir. At 15 weeks, pouch appearances were improved, no histological evidence of CMV was found and baseline pouch function had returned. This case highlights that CD can present many years after surgery for apparent UC. Also, CMV pouchitis should be considered as a differential cause of pouchitis especially as it is treatable with antiviral therapy.

Topics: Adult; Anal Canal; Anastomosis, Surgical; Antiviral Agents; Chronic Disease; Colectomy; Colitis, Ulcerative; Colonic Pouches; Crohn Disease; Cytomegalovirus; Cytomegalovirus Infections; Diarrhea; Endoscopy; Female; Ganciclovir; Humans; Inflammation; Postoperative Complications; Pouchitis; Proctocolectomy, Restorative; Ulcer; Valganciclovir; Weight Loss

This case describes a patient in whom cytomegalovirus (CMV) infected a preexisting ulcer. The patient was immune-suppressed because of treatment for Wegener's granulomatosis. Specific antiviral therapy was delayed because of uncertainty as to the role of CMV, but the infection cleared and the ulcer improved promptly on institution of valganciclovir.

Topics: Aged; Antiviral Agents; Cytomegalovirus Infections; Ganciclovir; Granulomatosis with Polyangiitis; Humans; Immunocompromised Host; Male; Ulcer; Valganciclovir