Endoscopic and Clinical Features of Cytomegalovirus Colitis in Critically Ill Patients: A Retrospective Review

Ding Ek Toh, Chun Nan Chen, Tze Sian Chan, Gi Shih Lien, Fat Moon Suk

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Abstract

Background: Patients with cytomegalovirus (CMV) colitis have increasingly been recognized among critically ill patients, yet few specific clinical and endoscopic features are known. In this study, we investigated the common clinical and endoscopic features of CMV colitis in critically ill patients. Methods: From January 1, 2000 to February 28, 2014, patients with a histopathological diagnosis of CMV colitis were retrospectively reviewed. We reviewed and analyzed the clinical presentation, primary diseases, serum CMV antibody, treatment, mortality, and endoscopic features of these patients. Results: Eighteen patients were diagnosed as having CMV colitis and 15 CMV colitis patients were included in this study. The mean age was 65.7 years (range 42-92 years). Bloody diarrhea and persistent diarrhea were the most common initial presentations of CMV, and sepsis was the most common comorbidity found. CMV-IgM was positive in three (17%) patients, and CMV-IgG was positive in 14 (93.3%) patients. All patients received ganciclovir and 11 patients clinically improved. Four (26.6%) patients died and two patients had colon perforation. According to the severity of the diseases, endoscopic presentation of CMV colitis ranged from colonic mucosa edema, loss of vasculature, subepithelial hemorrhage, and circular or geographic ulcers to perforation. Ten (66.7%) patients had multiple ulcers and five (33.3%) patients had a single ulcer. Eleven (73.3%) patients had colitis involving distal to splenic flexure, and four (26.6%) patients had colitis involving the whole colon. Conclusion: Critically ill patients who present with bloody stool or persistent diarrhea should be considered for the diagnosis of CMV colitis. The endoscopic presentation of CMV colitis is highly variable. We suggest that the endoscopic manifestation of CMV colitis can be divided into three stages: nonulcerative inflammatory stage, simple ulcerative stage, and complicated ulcerative stage.

Original languageEnglish
Pages (from-to)209-212
Number of pages4
JournalJournal of Experimental and Clinical Medicine(Taiwan)
Volume6
Issue number6
DOIs
Publication statusPublished - Dec 1 2014

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Colitis
Cytomegalovirus
Critical Illness
Ulcer
Diarrhea
Colon
Transverse Colon
Ganciclovir

Keywords

  • Critically ill patient
  • Cytomegalovirus colitis
  • Endoscopy

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{c3634a014f32470e81d5fce2c5c49c17,
title = "Endoscopic and Clinical Features of Cytomegalovirus Colitis in Critically Ill Patients: A Retrospective Review",
abstract = "Background: Patients with cytomegalovirus (CMV) colitis have increasingly been recognized among critically ill patients, yet few specific clinical and endoscopic features are known. In this study, we investigated the common clinical and endoscopic features of CMV colitis in critically ill patients. Methods: From January 1, 2000 to February 28, 2014, patients with a histopathological diagnosis of CMV colitis were retrospectively reviewed. We reviewed and analyzed the clinical presentation, primary diseases, serum CMV antibody, treatment, mortality, and endoscopic features of these patients. Results: Eighteen patients were diagnosed as having CMV colitis and 15 CMV colitis patients were included in this study. The mean age was 65.7 years (range 42-92 years). Bloody diarrhea and persistent diarrhea were the most common initial presentations of CMV, and sepsis was the most common comorbidity found. CMV-IgM was positive in three (17{\%}) patients, and CMV-IgG was positive in 14 (93.3{\%}) patients. All patients received ganciclovir and 11 patients clinically improved. Four (26.6{\%}) patients died and two patients had colon perforation. According to the severity of the diseases, endoscopic presentation of CMV colitis ranged from colonic mucosa edema, loss of vasculature, subepithelial hemorrhage, and circular or geographic ulcers to perforation. Ten (66.7{\%}) patients had multiple ulcers and five (33.3{\%}) patients had a single ulcer. Eleven (73.3{\%}) patients had colitis involving distal to splenic flexure, and four (26.6{\%}) patients had colitis involving the whole colon. Conclusion: Critically ill patients who present with bloody stool or persistent diarrhea should be considered for the diagnosis of CMV colitis. The endoscopic presentation of CMV colitis is highly variable. We suggest that the endoscopic manifestation of CMV colitis can be divided into three stages: nonulcerative inflammatory stage, simple ulcerative stage, and complicated ulcerative stage.",
keywords = "Critically ill patient, Cytomegalovirus colitis, Endoscopy",
author = "Toh, {Ding Ek} and Chen, {Chun Nan} and Chan, {Tze Sian} and Lien, {Gi Shih} and Suk, {Fat Moon}",
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T1 - Endoscopic and Clinical Features of Cytomegalovirus Colitis in Critically Ill Patients

T2 - A Retrospective Review

AU - Toh, Ding Ek

AU - Chen, Chun Nan

AU - Chan, Tze Sian

AU - Lien, Gi Shih

AU - Suk, Fat Moon

PY - 2014/12/1

Y1 - 2014/12/1

N2 - Background: Patients with cytomegalovirus (CMV) colitis have increasingly been recognized among critically ill patients, yet few specific clinical and endoscopic features are known. In this study, we investigated the common clinical and endoscopic features of CMV colitis in critically ill patients. Methods: From January 1, 2000 to February 28, 2014, patients with a histopathological diagnosis of CMV colitis were retrospectively reviewed. We reviewed and analyzed the clinical presentation, primary diseases, serum CMV antibody, treatment, mortality, and endoscopic features of these patients. Results: Eighteen patients were diagnosed as having CMV colitis and 15 CMV colitis patients were included in this study. The mean age was 65.7 years (range 42-92 years). Bloody diarrhea and persistent diarrhea were the most common initial presentations of CMV, and sepsis was the most common comorbidity found. CMV-IgM was positive in three (17%) patients, and CMV-IgG was positive in 14 (93.3%) patients. All patients received ganciclovir and 11 patients clinically improved. Four (26.6%) patients died and two patients had colon perforation. According to the severity of the diseases, endoscopic presentation of CMV colitis ranged from colonic mucosa edema, loss of vasculature, subepithelial hemorrhage, and circular or geographic ulcers to perforation. Ten (66.7%) patients had multiple ulcers and five (33.3%) patients had a single ulcer. Eleven (73.3%) patients had colitis involving distal to splenic flexure, and four (26.6%) patients had colitis involving the whole colon. Conclusion: Critically ill patients who present with bloody stool or persistent diarrhea should be considered for the diagnosis of CMV colitis. The endoscopic presentation of CMV colitis is highly variable. We suggest that the endoscopic manifestation of CMV colitis can be divided into three stages: nonulcerative inflammatory stage, simple ulcerative stage, and complicated ulcerative stage.

AB - Background: Patients with cytomegalovirus (CMV) colitis have increasingly been recognized among critically ill patients, yet few specific clinical and endoscopic features are known. In this study, we investigated the common clinical and endoscopic features of CMV colitis in critically ill patients. Methods: From January 1, 2000 to February 28, 2014, patients with a histopathological diagnosis of CMV colitis were retrospectively reviewed. We reviewed and analyzed the clinical presentation, primary diseases, serum CMV antibody, treatment, mortality, and endoscopic features of these patients. Results: Eighteen patients were diagnosed as having CMV colitis and 15 CMV colitis patients were included in this study. The mean age was 65.7 years (range 42-92 years). Bloody diarrhea and persistent diarrhea were the most common initial presentations of CMV, and sepsis was the most common comorbidity found. CMV-IgM was positive in three (17%) patients, and CMV-IgG was positive in 14 (93.3%) patients. All patients received ganciclovir and 11 patients clinically improved. Four (26.6%) patients died and two patients had colon perforation. According to the severity of the diseases, endoscopic presentation of CMV colitis ranged from colonic mucosa edema, loss of vasculature, subepithelial hemorrhage, and circular or geographic ulcers to perforation. Ten (66.7%) patients had multiple ulcers and five (33.3%) patients had a single ulcer. Eleven (73.3%) patients had colitis involving distal to splenic flexure, and four (26.6%) patients had colitis involving the whole colon. Conclusion: Critically ill patients who present with bloody stool or persistent diarrhea should be considered for the diagnosis of CMV colitis. The endoscopic presentation of CMV colitis is highly variable. We suggest that the endoscopic manifestation of CMV colitis can be divided into three stages: nonulcerative inflammatory stage, simple ulcerative stage, and complicated ulcerative stage.

KW - Critically ill patient

KW - Cytomegalovirus colitis

KW - Endoscopy

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