CMV in Moderately Active Colitis: Much Ado About Nothing?

Excerpt

Cytomegalovirus (CMV) infection is prevalent in ~70% of patients with inflammatory bowel disease (IBD), but whether this virus contributes to disease severity or adverse outcomes has long been a matter of debate [1, 2]. After initial infection, CMV enters a latent phase that has no clinical consequences, unless the virus is re-activated in the colon during periods of physiological stress or immunosuppression. If CMV is re-activated, local cytopathic effects in the colon can lead to a symptomatic colitis (CMV disease) that is very similar to IBD. In patients with severe and/or steroid-refractory colitis, there is evidence that such colonic CMV re-activation occurs in approximately 30% of cases [3]. Clinical guidelines have recommended that we test for colonic CMV disease in patients with severe colitis, and treat CMV+ patients with antiviral therapy [4, 5]. …