Affiliation:
1. Kuban State Medical University; Regional Clinical Hospital No. 2
2. Regional Clinical Hospital No. 2
3. Kuban State Medical University
Abstract
Ulcerative colitis is a chronic autoimmune disease characterized by inflammation of colonic mucous layer. Patients affected with ulcerative colitis are often subjected to immunosuppressive therapy that makes them susceptible to opportunistic infections. This article presents clinical case of moderate-to-severe ulcerative colitis, complicated by cytomegalovirus infection. We demonstrated the necessity of the inclusion of cytomegalovirus infection into the differential diagnostic algorithm of ulcerative colitis relapse using molecular methods of diagnosis. Also, we justified the choice of specific antiviral therapy and first line biological therapy in a bionaive steroid-dependent, refractory to thiopurines patient. The choice of ustekinumab as therapeutic armamentarium showed to be safe and effective in attainment and maintenance of persistent clinical, laboratory and endoscopic remission in a patient affected with ulcerative colitis with intestinal reactivation of cytomegalovirus infection.
Reference21 articles.
1. Шелыгин Ю.А., Ивашкин В. Т., Белоусова Е.А. и др. Клинические рекомендации. Язвенный колит (К51), взрослые 2023. Колопроктология. 2023; 22 (1): 10–44. https://doi.org/10.33878/2073–7556–2023–22–1–10–44 Shelygin Yu.A., Ivashkin V.T., Belousova E.A. and others. Clinical recommendations. Ulcerative colitis (K51), adults 2023. Coloproctology. 2023; 22 (1): 10–44. https://doi.org/10.33878/2073–7556–2023–22–1–10–44
2. Валганцикловир в рецидивирующих приступах криптогенных воспалительных заболеваний кишечника с инфекцией цитомегаловирусом: MICI–CMV. ICH GCP: Реестр клинических испытаний США. Клинические испытания NCT00237653. https://clinicaltrials.gov Valganciclovir in recurrent attacks of cryptogenic inflammatory bowel disease with cytomegalovirus infection: MICI–CMV. ICH GCP: US Clinical Trials Registry. Clinical trial NCT00237653. https://clinicaltrials.gov
3. Волчкова Е. В., Белоусова Е.А., Богомазов Ю.К. и др. Оппортунистические инфекции при воспалительных заболеваниях кишечника: цитомегаловирус – клиническое наблюдение. Фарматека для практикующих врачей. 2010; 15: 118–122. Volchkova E. V., Belousova E. A., Bogomazov Yu.K. and others. Opportunistic infections in inflammatory bowel diseases: cytomegalovirus – clinical observation. Pharmacy for Medical Practitioners. 2010; 15: 118–122.
4. Rahier J. F., Magro F., Abreu C., et al. European Crohn's and Colitis Organisation (ECCO). Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. JCC; 2014: 8 (6): 443–468. https://doi.org/10.1016/j.crohns.2013.12.013
5. Powell R.D., Warner N.E., Levine R. S., et al. Cytomegalic inclusion disease and ulcerative colitis. Report of a case in a young adult. Am J Med. 1961; 30: 334–340. https://doi.org/10.1016/0002–9343(61)90105-x.