I've encountered an 60 y/o/ female presenting with diarrhea and PR bleeding (anemia).Both colonoscopy and histopathology findings were suggestive of CMV colitis (includion body, positive stain) and UC.
First you must perform the PCR test for viral DNA in tissue (biopsy) and blood, then you should treate her with ganciklovir (Cymevene) for 4 weeks. First 14 days parenteral 5mg/kg IV then she must take tablets for 3-4 another weeks (maintenace therapy).. After tretment there must be a PCR control test performed.
Dr Davorin, Thanks for your input.
Do you have any opinion if any difference between giving just a two to three weeks iv ganciclovir, and your 4 weeks ganciclovir?
About the ulcerative colitis, besides 5 ASA, would you start IV hydrocortisone immediately, or you prefer to treat the CMV colitis first before starting steroid? (as we are cdoncerned of the immunosuppresion induced by steroid may make the CMV infection worse)
I dont have any expirience with shorter therapy protokols, but sure, yes it can help too
I Will wait with coticosteroid, specialy if there is no evidence for heavy blood dirrhea.But if there are some severe extragastrointestinal disorders (piogen gangrenosum or sever artritic pain)
CMV infection must be distinguished from CMV disease. CMV infection does not always mean CMV disease. Histology is the gold standard for the diagnosis of CMV colitis, in UC patients. Biopsy positive, PCR positive and CMV-IGM antibodies positive, may indicate more severe disease and could be benefit from the treatment. Discontinuation of corticosteroids is not necessary, for every patient. Ganciclovir is given of 5mg/Kg IV, twice per day, for 15 days. After 5 days of IV administration the patient can be switched to oral ganciclovir.
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