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Colon, rectum and anus
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Other conditions that enter the differential diagnosis include tuberculous infections, amoebic dysentery, bilharzial infestations of the colon, Salmonella enteritis and colitis, Campylobacter infections, antibiotic-associated pseudomembranous colitis, necrotising enterocolitis, radiation-induced colitis and enteritis, ischaemic colitis (rare under age 60), complicated diverticular disease (especially with internal fistula), pneumatoides cystoides intestinalis (early stages) and primary cytomegalovirus colitis (can simulate or complicate UC).
Gastrointestinal bleeding
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Manjula Velayudhan, Mike Thomson
Causes of colitisCytomegalovirus colitisEscherichia coli 0157:H7Entamoeba histolyticaJuvenile polypsIschaemic colitisTyphilitisInflammatory bowel diseaseNeisseria gonorrhoeaeHaemolytic uraemic syndrome
Gastrointestinal and hepatobiliary
Published in Dave Maudgil, Anthony Watkinson, The Essential Guide to the New FRCR Part 2A and Radiology Boards, 2017
Dave Maudgil, Anthony Watkinson
The following conditions are abdominal manifestations of acquired immune deficiency syndrome (AIDS). True or false? Peliosis hepatis.Cholangiopathy.Enteropathy.Cholangiocarcinoma.CMV (cytomegalovirus) colitis.
Safety evaluation of ustekinumab for moderate-to-severe ulcerative colitis
Published in Expert Opinion on Drug Safety, 2022
Jun Miyoshi, Minoru Matsuura, Tadakazu Hisamatsu
In the induction phase of the UNIFI study [15], 15.9% (51/321), 15.9% (51/320), and 15.4% (49/319) of patients in the 130 mg UST, 6 mg/kg UST, and placebo groups, respectively, reported infections. Serious infections were reported in 0.6% (2/321), 0.3% (1/320), and 1.6% (5/319) of the patients in these groups, respectively. In the maintenance phase of the UNIFI study, infections were reported in 33.7% (58/172), 48.9% (86/176), and 46.3% (81/175) of patients in the 90 mg/12 weeks UST, 90 mg/8 weeks UST, and placebo groups, respectively. Additionally, 3.5% (6/172), 1.7% (3/176), and 2.3% (4/175) of the patients in these groups, respectively, experienced serious infections. Potential opportunistic infections occurred in 4 of 825 patients who received UST. In these four patients, there was one case of Legionella pneumonia during the induction phase, two cases of cytomegalovirus colitis, and one case of concurrent ophthalmic and oral herpes simplex infections during the maintenance phase [15]. In the UNIFI-LTE study, the numbers of infections per 100 patient-years of follow-up were 83.51, 91.03, and 81.66 in the 90 mg/12 weeks UST, 90 mg/8 weeks UST, and placebo groups, respectively [34]. The numbers of serious infections in these groups were 4.15, 1.71, and 2.38, respectively. Two serious infections considered opportunistic were reported, including one case of cytomegalovirus colitis (>60 years old) and one case of blood culture positivity for Listeria monocytogenes.
Colonoscopy was useful for the diagnosis and the guidance of treatment escalation/de-escalation in a refractory case of lupus colitis
Published in Modern Rheumatology Case Reports, 2018
Shinya Hirahara, Yasuhiro Katsumata, Masanori Hanaoka, Yuko Kurohori, Yasushi Kawaguchi, Atsuko Hiroi, Yoji Nagashima, Hisashi Yamanaka
Appropriate differentiation of lupus colitis from other mimicking diseases is very important because their treatments could be conflicting. In particular, in already treated SLE cases, differentiation from infective colitis such as cytomegalovirus colitis is very important [2]. Although lymphopenia, cytotoxic treatment, and presence of renal disease are predisposing factors for cytomegalovirus colitis [2], they cannot totally exclude the possibility of lupus colitis as in the present case. Thus, colonoscopic biopsy is also useful for the differentiation of cytomegalovirus colitis, which typically presents with intranuclear or cytoplasmic inclusion. Although lupus colitis might be indistinguishable from ulcerative colitis both clinically and pathologically [2], the typical pathologic features of ulcerative colitis, such as frank crypt abscesses, are not observed in lupus colitis as in the present case. In addition, ulcerative colitis is rarely associated with SLE [2]. Colonoscopic and pathologic features of lupus colitis are not established due to its rarity [2], although vasculitis was observed in some cases [4,5]. Iwamuro et al. [10] reported that they underwent colonoscopy in 29 SLE patients and observed discrete ulcers (n = 5), longitudinal ulcers (n = 1), erosions and/or small ulcers (n = 2), oedematous mucosa (n = 2), and concurrent ulcerative colitis (n = 1).
Cytomegalovirus infection in the setting of occult ulcerative colitis: case report and review of the literature
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Mustafa Dawood, Abubakar Tauseef, Janki Patel
There are several cases in the worldwide literature of patients with established inflammatory bowel disease developing an acute exacerbation secondary to cytomegalovirus disease [2–5]. The vast majority of cases of CMV infection have been in patients with ulcerative colitis; only one case had Crohn ileocolitis [6] and one had indeterminate colitis [3]. Begos, et al concluded from their investigations that patients with inflammatory bowel disease complicated by cytomegalovirus colitis had a 67% colectomy rate and 33% mortality rate [7]. Another study conducted by Orvar, et al, suggested that onset of CMV infection might act as a triggering factor for the presentation of ulcerative colitis. [8] We treated the CMV infection in the patient. In the study conducted by Van Dorp, et al, it showed that CMV infection in tissue culture causes the induction of MHC I surface antigen expression in monocytes. Thus, CMV infection in colonocytes may trigger an autoimmune response in the susceptible host which leads to the manifestation of ulcerative colitis [9]. Previous reports relied heavily on biopsy evidence before the start of ganciclovir therapy. Histology demonstrating the classical appearance of ‘owl’s eye’ inclusion bodies is the gold standard test for cytomegalovirus diagnosis. Xiaoyan et.al in his study demonstrated that biopsies which had > 2 Immunohistochemical stains positive for CMV and positive PCR in the serum were truly infective and recommended treatment with ganciclovir. Biopsies which had 1–2 IHC stains positive for CMV were probably ‘innocent bystanders’ and did not recommend treatment unless they were immunocompromised or post-transplant patient where treatment was recommended irrespective of the number of cells with positive stains and CMV viremia [10].