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