Naseem Zehra, Nadeem Ahmed, David Aidan J, Muhammad Aun, Shah Fatima Zehra, Fung Brian M, Hanauer Stephen B, David Joseph
Department of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
College of Arts and Sciences, Case Western Reserve University, Cleveland, OH, USA.
Case Rep Gastroenterol. 2025 May 13;19(1):352-357. doi: 10.1159/000545642. eCollection 2025 Jan-Dec.
Cytomegalovirus (CMV) infection is a notable gastrointestinal infection affecting immunocompromised patients. In the gastrointestinal tract, CMV often presents with patchy or diffuse mucosal involvement and can cause fulminant colitis. However, polypoid CMV lesions are rare. We present a case of a 49-year-old man with ulcerative colitis (UC) in remission on ozanimod who developed CMV isolated to inflammatory colon polyps.
A 49-year-old patient with UC in clinical remission on ozanimod underwent routine surveillance colonoscopy, which revealed multiple inflamed polyps with white caps. Biopsy results confirmed inflammatory polyps with positive CMV immunostaining, while adjacent tissues and plasma CMV PCR tests were negative. The patient successfully completed a 3-week course of valganciclovir. Follow-up colonoscopy revealed additional inflammatory polyps but no evidence of CMV. He remained in clinical remission and continued ozanimod therapy.
The unusual nature of this presentation suggests a clinically silent CMV reactivation or, alternatively, a primary CMV infection in our patient, with an unclear natural history and optimal management. This report emphasizes the importance of considering CMV in UC patients with unusual endoscopic findings and the need for multidisciplinary collaboration to optimize care.
巨细胞病毒（CMV）感染是一种影响免疫功能低下患者的显著胃肠道感染。在胃肠道中，CMV常表现为散在或弥漫性黏膜受累，并可导致暴发性结肠炎。然而，息肉样CMV病变罕见。我们报告一例49岁男性，患有溃疡性结肠炎（UC），正在服用奥扎莫德且病情缓解，其CMV感染局限于炎性结肠息肉。
一名49岁患有UC且临床病情缓解、正在服用奥扎莫德的患者接受了常规监测结肠镜检查，结果发现多个有白色帽状物的炎性息肉。活检结果证实为炎性息肉，CMV免疫染色呈阳性，而相邻组织和血浆CMV聚合酶链反应（PCR）检测均为阴性。患者成功完成了为期3周的缬更昔洛韦疗程。随访结肠镜检查发现了更多炎性息肉，但未发现CMV迹象。他仍处于临床缓解状态，并继续接受奥扎莫德治疗。
这种表现的不寻常性质提示我们的患者存在临床上无症状的CMV再激活，或者是原发性CMV感染，其自然病史和最佳治疗方案尚不清楚。本报告强调了在有异常内镜检查结果的UC患者中考虑CMV感染的重要性，以及多学科协作以优化治疗的必要性。
