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GI tract infections in IBD: Detection and treatment of Clostridium difficile , CMV and enteric pathogens: Case studies. David G. Binion , MD Bruce E. Sands, MD, MS. Case 1: Steroid-Refractory Colitis. 22 yo man admitted for severe colitis - PowerPoint PPT Presentation
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GI tract infections in IBD: Detection and treatment of Clostridium difficile,
CMV and enteric pathogens: Case studies
David G. Binion, MDBruce E. Sands, MD, MS
Case 1: Steroid-Refractory Colitis
• 22 yo man admitted for severe colitis• Diagnosed with UC at age 17, maintained on
mesalamine• Three weeks ago, onset of 8 loose, bloody
stools/day with urgency, tenesmus• Began prednisone 40 mg/d 18 days ago• Exam
– Afebrile, VSS– Abdomen: active bowel sounds, soft, nontender, no
HSM
Case 1: Steroid-Refractory Colitis
• What diagnostic tests on admission?
Endoscopic appearance of the severe colitis affecting the rectosigmoid
Hamlin P J et al. Postgrad Med J 2004;80:233-235
Case 1: Steroid-Refractory Colitis
• After 5 days of hydrocortisone 100 mg Q8h IV, he continues to have in excess of 12 stools a day
• What are the data regarding CMV as a contributing factor in steroid-refractory ulcerative colitis?
Case 1: Steroid-Refractory ColitisDiagnostic Tests for CMV
Nguyen M, et al. Ulcers 2011:doi10.1155/2011/282507
Studies of CMV+ Patients with Steroid-Refractory UC Who Experienced Clinical
Response After Addition of Anti-Viral Therapy
Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7
Prevalence of CMV in Endoscopic Colonic Biopsies from Patients
with Steroid-Refractory Colitis
Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7
CMV-infected Cell
Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7
CMV-colitis
Ayre K, et al. J Crohn’s Colitis 2009;3:141-8