Protracted primary cytomegalovirus infection presenting as ileoanal pouchitis in a non-immunosuppressed patient: a case reportReportar como inadecuado

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Journal of Medical Case Reports

, 8:163

First Online: 26 May 2014Received: 03 October 2013Accepted: 27 January 2014DOI: 10.1186-1752-1947-8-163

Cite this article as: Rupp, C., Herpel, E., Schnitzler, P. et al. J Med Case Reports 2014 8: 163. doi:10.1186-1752-1947-8-163


IntroductionPouchitis often occurs after proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis. It is usually deemed idiopathic and commonly responds to antibacterial therapy. To date, only a few cases of cytomegalovirus pouchitis have been documented, and only a single report describes pouchitis in a case of assumed primary cytomegalovirus infection.

Case presentationA 26-year-old Caucasian woman underwent proctocolectomy and ileal pouch-anal anastomosis for refractory ulcerative colitis and adenocarcinoma. After 28 months she developed bloody diarrhoea, abdominal pain, fever, nausea and general malaise suggesting severe pouchitis. Antibiotic treatment reduced humoral inflammation, but failed to resolve her fever. A pouchoscopy revealed distinct pouchitis, and cytomegalovirus infection was diagnosed from pouch biopsies by polymerase chain reaction as well as conventional histology and immunohistochemistry. The infection was confirmed in her blood by polymerase chain reaction and pp65 antigen test, and was clearly defined as the ‘primary’ infection by serial serological tests. Intravenous treatment with ganciclovir 10mg-kg body weight-day led to resolution of symptoms and negative cytomegalovirus deoxyribonucleic acid and pp65 within a few days. When symptoms and laboratory evidence of cytomegalovirus infection recurred a few days after completing 20 days of therapy with ganciclovir and valganciclovir, a second course of ganciclovir treatment was initiated.

ConclusionsCytomegalovirus infection of the ileoanal pouch is an important differential diagnosis of pouchitis even in non-immunosuppressed patients and can be treated with ganciclovir.

KeywordsCytomegalovirus Pouchitis Primary infection Ulcerative colitis AbbreviationsCMVCytomegalovirus

CRPC-reactive protein

IBDInflammatory bowel disease


IPAAIleal pouch-anal anastomosis


PCRPolymerase chain reaction

UCUlcerative colitis.

Electronic supplementary materialThe online version of this article doi:10.1186-1752-1947-8-163 contains supplementary material, which is available to authorized users.

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Autor: Christian Rupp - Esther Herpel - Paul Schnitzler - Anna Zawierucha - Philipp Zwickel - Lukas Klute - Martina Kadmon - Wolfg


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