Evidence of Epstein-Barr and cytomegalovirus co-infection in ulcerative colitis

Abstract number: 1734_90

Pape M., Mandraveli K., Papadopoulou D., Sidiropoulos I., Koliouskas D., Alexiou-Daniel S.

Objective: The aim of our study was to emphasize the possible role of infectious agents (EBV, CMV) in persistent ulcerative colitis (UC).

Methods: We report a case of exacerbation of ulcerative colitis in a female patient who admitted to the gastroenterology clinic of AHEPA University Hospital due to frequent bloody diarrhoea (>10 times a day). The patient had a pre-existing history of refractory ulcerative colitis and was treated with corticosteroids or immunosuppressants during acute attacks. A full-length colonoscopy was performed and multiple biopsies were obtained for histological examination of inflammation and inclusion bodies and for extraction of DNA for PCR. Computed tomography (CT), general laboratory (WBC, AST, ALT, TKE, CRP) and serological tests were also performed. Using Real-time PCR, biopsy and peripheral blood specimens were tested for the most frequently identified viral pathogens of colitis (CMV, EBV, HSV, VZV).

Results: The abdominal computed tomography (CT) scan did not revealed any abnormalities. The endoscopic and histological findings (severe erosive and edematous mucosa throughout the colon, heavy inflammatory infiltrate with epithelial ulceration) were consistent with UC. No CMV inclusion bodies were detected. The initial laboratory tests were normal except a slightly increased level of CRP. Serological tests for anti-CMV, anti-EBV, anti-HSV and anti-VZV IgG/IgM antibodies excluded primary infection or reactivation. EBV and CMV viral genome was detected only in tissue samples (2.4×10⁴ copies/mL, 1.3×10³ copies/mL, respectively). In blood samples no viral genome was detected. The patient was started on treatment with acyclovir at an oral dosage of 800 mg, five times daily for 5 days, with good resolution of the symptomatology. A further colonoscopy examination showed a clear improvement in the previous picture, with no evidence of inflammation. At that time, PCR on biopsy materials was once more performed, but no EBV or CMV genome was traced. The patient has remained symptom-free since then.

Conclusion: UC patients undergoing immunosuppresive therapy are exposed to an excessive risk of viral infection. We believe that patients with refractory UC should be tested for virus infection before increasing the dose or the number of immunosuppressive drugs. PCR techniques considered to be the most sensitive tool for virus detection and management of infections of the gastrointestinal tract.