Chiba Mitsuro, Abe Toru, Tsuda Satoko, Ono Iwao
Division of Gastroenterology, Akita, Japan.
BMC Res Notes. 2013 Feb 2;6:40. doi: 10.1186/1756-0500-6-40.
In 2009, a trigger role of cytomegalovirus (CMV) was shown in the development of ulcerative colitis (UC) in mice. Fifteen cases of synchronous onset of CMV colitis and UC have been reported in literature. A careful prospective and retrospective survey identified CMV colitis in newly diagnosed UC patients at 4.5% (3/65 cases) and 8.2% (5/61 cases), respectively. This means that a majority of synchronous CMV colitis may be missed in newly diagnosed UC patients in routine practice. Such a case is presented.
A 50-year-old woman, with a history of right partial mastectomy two years ago, had a persistent high fever for 9 days, after which a thickness of the colonic wall was detected on abdominal ultrasonography. Laboratory data showed inflammation and 2% atypical lymphocytes with the normal number of white blood cells. Although there was no bloody stool, fecal occult blood was over 1000 ng/ml. Colonoscopy showed diffuse inflammation in the entire large bowel and pseudomembranes in the sigmoid colon. The diagnosis was UC with antibiotic-associated pseudomembranous colitis. Metronidazole followed by sulfasalazine resulted in defervescence and improvement in laboratory data of inflammation. It took one month for normalization of fecal occult blood. Endoscopic remission was simultaneously confirmed. Later, it was found that a report of positive CMV antigenaemia (2/150,000) had been missed. Reevaluation of biopsy specimens using a monoclonal antibody against CMV identified positive cells, although inclusion bodies were not found in hematoxylin and eosin sections. Finally, the case was concluded to be synchronous onset of CMV colitis and UC.
Synchronous CMV colitis is not routinely investigated in newly diagnosed UC patients. Together with a recent observation in animal studies, it is plausible that a subset (a few to several per cent) of UC patients develop synchronous CMV infection. Further studies are needed to elucidate the plausibility.
2009年，有研究表明巨细胞病毒（CMV）在小鼠溃疡性结肠炎（UC）的发病过程中起触发作用。文献报道了15例CMV结肠炎与UC同步发病的病例。一项细致的前瞻性和回顾性调查分别在新诊断的UC患者中发现CMV结肠炎的比例为4.5%（3/65例）和8.2%（5/61例）。这意味着在常规诊疗中，大多数新诊断的UC患者可能会漏诊同步发生的CMV结肠炎。现报告这样一例病例。
一名50岁女性，两年前有右半乳房切除术史，持续高热9天，之后腹部超声检查发现结肠壁增厚。实验室检查显示有炎症，白细胞数量正常，非典型淋巴细胞占2%。虽无血便，但粪便潜血超过1000 ng/ml。结肠镜检查显示全大肠弥漫性炎症，乙状结肠有假膜。诊断为UC合并抗生素相关性假膜性结肠炎。甲硝唑治疗后改用柳氮磺胺吡啶，热退，炎症相关实验室检查结果改善。粪便潜血恢复正常用了1个月时间，同时内镜检查确认病情缓解。后来发现一份CMV抗原血症阳性报告（2/150,000）被漏检。使用抗CMV单克隆抗体重新评估活检标本发现了阳性细胞，尽管苏木精-伊红切片中未发现包涵体。最终，该病例被诊断为CMV结肠炎与UC同步发病。
新诊断的UC患者通常不会常规检查是否合并同步发生的CMV结肠炎。结合近期动物研究的观察结果，有一部分（百分之几）UC患者发生同步CMV感染是有可能的。需要进一步研究以阐明这种可能性。
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