Background: Cytomegalovirus (CMV) infection was seen frequently among hospitalized patients with ulcerative colitis (UC). Infected patients are more likely to become hospitalized, have longer lengths of stay, and higher mortality rates. However, the risk factor of CMV infection in UC is not well understood. The aim of this study was to determine the prevalence of CMV infection in UC patients and identify the risk factors for CMV infection among hospitalized patients with UC.
Methods: Between January 2010 and December 2014, 131 patients diagnosed with UC and 88 patients were hospitalized at Pusan National University Hospital. We were retrospectively reviewed their medical records including disease severity, treatment & CMV infection by histological examinations. The clinical disease activity of UC was assessed using Modified mayo-score. CMV disease was defined as CMV inclusion bodies in biopsy specimens, or positive specific immunohistochemical staining for CMV. Differences in risk factors were determined between patients with UC and CMV and those with UC without CMV.
Results: Eighty-eight patient with UC were hospitalized at Pusan National University Hospital during study period. Among those, 31 patients (31/88, 35.2%) were diagnosed CMV infection. Modified mayo-score was significantly higher in patients with UC and CMV infection than those with UC without CMV (p=0.02). Also, steroid was a risk factor of CMV infection (p=0.014). In contrast, no association was seen with sex, age, the extent of disease, immunomodulator or anti TNF-α inhibitor use. All of the CMV-positive patients received immunosuppressive treatments.
Conclusions: CMV infection in hospitalized patients with UC is associated with steroid therapy and severe colonic inflammation. CMV infection should be suspected in steroid dependent patients with active UC. More rapid diagnosis and timely initiation of antiviral therapy for CMV-associated colitis in patients with UC are needed.