Detection of CMV in pouch mucosa in a patient with acute pouchitis: The real enemy or an innocent bystander?

摘要

A 30-year-old woman was diagnosed with fulminant UC in 2003 during lactation. She underwent proctocolectomy with iteal pouch-anal anastomosis due to intractable symptoms and conservative treatment failure. In August 2011, she presented with 15-20 liquid bowel movements per day accompanied with fever, abdominal tenderness and elevated laboratory markers of inflammation. A week before the onset of symptoms she reported camping holidays. A pouchoscopy revealed mild pouchitis. She was empirically treated for pou-chitis with ciprofloxacin (500 mg b.i.d.) and metronidazole (500 mg t.i.d.). She exhibited a partial response after 72 h but fever remained consistent up to 38.5 degC. Stool culture turned out positive for ciprofloxacin sensitive Salmonella species. Noticeably, CMV serology revealed a positive index value with a high titer for IgG antibodies. A second pouchoscopy after 4 days of treatment revealed endoscopic exacerbation.