TY - JOUR
TI - Synchronous cytomegalovirus and Clostridium difficile infection of the pouch: A trigger for chronic pouchitis?
AU - Papaconstantinou, I.
AU - Zampeli, E.
AU - Dellaportas, D.
AU - Giannopoulos, C.
AU - Sotiropoulou, M.
AU - Polymeneas, G.
AU - Bamias, G.
AU - Michopoulos, S.
JO - Clinical Journal of Gastroenterology
PY - 2014
VL - 7
TODO - 2
SP - 132-135
PB - Springer-Verlag Tokyo
SN - 1865-7257, 1865-7365
TODO - 10.1007/s12328-014-0458-6
TODO - C reactive protein;  ciprofloxacin;  ganciclovir;  mesalazine;  metronidazole;  vancomycin;  VSL3, abdominal pain;  adolescent;  article;  bloody diarrhea;  case report;  cell inclusion;  chronic idiopathic pouchitis;  Clostridium difficile infection;  colon resection;  cytomegalovirus infection;  disease severity;  drug withdrawal;  erythrocyte sedimentation rate;  fever;  gastrointestinal endoscopy;  human;  ileitis;  ileoanal anastomosis;  immunohistochemistry;  intestine biopsy;  maintenance therapy;  male;  priority journal;  proctocolectomy;  proctocolectomy with ileal pouch anal anastomosis;  recurrent disease;  ulcerative colitis;  chronic disease;  Clostridium infection;  colostomy bag;  complication;  cytomegalovirus infection;  ileitis;  microbiology;  Peptoclostridium difficile, Adolescent;  Chronic Disease;  Clostridium difficile;  Clostridium Infections;  Colonic Pouches;  Cytomegalovirus Infections;  Humans;  Male;  Pouchitis
TODO - Pouchitis occurs in up to one half of patients after restorative proctocolectomy with ileal pouch-anal anastomosis (IPAA). Cytomegalovirus (CMV) and Clostridium difficile are among the commonest secondary identifiable etiologies. A 17-year-old male with ulcerative colitis underwent IPAA due to refractory disease. Nine months later he experienced bloody diarrhea and fever. Laboratory testing and endoscopy confirmed pouch inflammation. Testing for C. difficile toxins A and B was positive. Histology revealed affluent inclusion bodies and immunohistochemistry detected reactivity against CMV protein. Treatment with metronidazole and vancomycin offered partial improvement, whereas the addition of gancyclovir led to a successful recovery. One month after completion of treatment symptoms recurred. Repeat testing precluded an identifiable infectious cause and the diagnosis of idiopathic chronic pouchitis was established. The patient is currently on maintenance treatment with the probiotic compound VSL#3. © 2014 Springer.
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