Introduction: Pouchitis often occurs after proctocolectomy and ileal pouch-anal anastomosis for ulcerative colitis. It is usually deemed idiopathic and commonly responds to antibacterial therapy. To date, only a few cases of cytomegalovirus pouchitis have been documented, even no single report describes pouchitis in a pediatric case of immune competent cytomegalovirus infection.
Case presentation: A 15-year-old adolescent underwent proctocolectomy and ileal pouch-anal anastomosis for refractory ulcerative colitis. After few months he developed bloody diarrhoea, nocturnal fecal incontinence, abdominal pain, fever and general malaise suggesting severe pouchitis.several Antibiotic treatment and prebiotics improved him for awhile, but failed to resolve his diarrhea. A pouchoscopy revealed distinct pouchitis, and cytomegalovirus infection was diagnosed from pouch biopsies by polymerase chain reaction as well as conventional histology and immunohistochemistry. The infection was confirmed in his blood by polymerase chain reaction .oral treatment with valganciclovir for 4 weeks led to resolution of symptoms.
Conclusions: Cytomegalovirus infection of the ileoanal pouch is an important differential diagnosis of pouchitis even in non-immunosuppressed patients and can be treated with valganciclovir.
Keywords: Cytomegalovirus; Pouchitis; Ulcerative colitis
References:
1. Christian Rupp, Esther Herpel, Paul Schnitzler, Anna Zawierucha, Philipp Zwickel1, Lukas Klute, Martina Kadmon, Wolfgang Stremmel: Protracted primary cytomegalovirus infection presenting as ileoanal pouchitis in a non-immunosuppressed patient.
Journal of Medical Case Reports 2014,8:163 .
2. Pardi DS, Sandborn WJ: Systematic review: the management of pouchitis.
Aliment Pharmacol Ther 2006, 23:1087-1096. PubMed Abstract | Publisher Full Text
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