Hookey L C, Depew W, Boag A, Vanner S
Gastroenterology Diseases Research Unit, Queen's University, Kingston, Ontario K7L 5G2, Canada.
Can J Gastroenterol. 2003 May;17(5):319-22. doi: 10.1155/2003/824547.
6-mercaptopurine (6-MP) and azathioprine are important drugs for the treatment of inflammatory bowel disease (IBD) but their actions suppress host defense against infection. A challenging case of a 19-year-old female patient with quiescent Crohn's disease maintained with 6-MP presenting with dyspnea and a normal chest exam and x-ray is presented. She became ventilator-dependent and only after numerous investigations was diagnosed with cytomegalovirus (CMV) pneumonitis. A systematic literature review of CMV infections in IBD patients was performed. The present case is the first report of a patient with quiescent IBD maintained on 6-MP who developed CMV pneumonitis. Other reports have identified patients with active disease on multiple immunosuppressants who developed CMV pneumonitis and also highlight the risk of CMV colitis in refractory IBD. The authors review the approach to the diagnosis of CMV infections in IBD patients with atypical pneumonia and colitis and highlight the importance of considering CMV infection in these settings.
6-巯基嘌呤（6-MP）和硫唑嘌呤是治疗炎症性肠病（IBD）的重要药物，但它们的作用会抑制宿主对感染的防御能力。本文介绍了一例具有挑战性的病例，一名19岁女性克罗恩病患者，病情处于缓解期，一直使用6-MP维持治疗，出现呼吸困难，胸部检查和X光检查均正常。她依赖呼吸机，经过多次检查后才被诊断为巨细胞病毒（CMV）肺炎。对IBD患者的CMV感染进行了系统的文献综述。本病例是首例关于病情缓解的IBD患者在使用6-MP治疗期间发生CMV肺炎的报告。其他报告还发现，使用多种免疫抑制剂的活动性疾病患者会发生CMV肺炎，同时也强调了难治性IBD患者发生CMV结肠炎的风险。作者回顾了IBD患者非典型肺炎和结肠炎中CMV感染的诊断方法，并强调了在这些情况下考虑CMV感染的重要性。
