GI tract infections in IBD: Detection and treatment of Clostridium difficile, CMV and enteric pathogens: Case studies David G. Binion, MD Bruce E. Sands,

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Presentation transcript:

GI tract infections in IBD: Detection and treatment of Clostridium difficile, CMV and enteric pathogens: Case studies David G. Binion, MD Bruce E. Sands, MD, MS

Case 1: Steroid-Refractory Colitis 22 yo man admitted for severe colitis Diagnosed with UC at age 17, maintained on mesalamine Three weeks ago, onset of 8 loose, bloody stools/day with urgency, tenesmus Began prednisone 40 mg/d 18 days ago Exam –Afebrile, VSS –Abdomen: active bowel sounds, soft, nontender, no HSM

Case 1: Steroid-Refractory Colitis What diagnostic tests on admission?

Endoscopic appearance of the severe colitis affecting the rectosigmoid Hamlin P J et al. Postgrad Med J 2004;80:

Case 1: Steroid-Refractory Colitis After 5 days of hydrocortisone 100 mg Q8h IV, he continues to have in excess of 12 stools a day What are the data regarding CMV as a contributing factor in steroid-refractory ulcerative colitis?

Case 1: Steroid-Refractory Colitis Diagnostic Tests for CMV Nguyen M, et al. Ulcers 2011:doi /2011/282507

Studies of CMV+ Patients with Steroid- Refractory UC Who Experienced Clinical Response After Addition of Anti-Viral Therapy Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7

Prevalence of CMV in Endoscopic Colonic Biopsies from Patients with Steroid-Refractory Colitis Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7

CMV-infected Cell Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7

CMV-colitis

Ayre K, et al. J Crohn’s Colitis 2009;3:141-8