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GI tract infections in IBD: Detection and treatment of Clostridium difficile , CMV and enteric pathogens: Case studies. David G. Binion , MD Bruce E. Sands, MD, MS. Case 1: Steroid-Refractory Colitis. 22 yo man admitted for severe colitis

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David G. Binion , MD Bruce E. Sands, MD, MS


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slide1

GI tract infections in IBD: Detection and treatment of Clostridium difficile, CMV and enteric pathogens: Case studies

David G. Binion, MD

Bruce E. Sands, MD, MS

case 1 steroid refractory colitis
Case 1: Steroid-Refractory Colitis
  • 22 yo man admitted for severe colitis
  • Diagnosed with UC at age 17, maintained on mesalamine
  • Three weeks ago, onset of 8 loose, bloody stools/day with urgency, tenesmus
  • Began prednisone 40 mg/d 18 days ago
  • Exam
    • Afebrile, VSS
    • Abdomen: active bowel sounds, soft, nontender, no HSM
case 1 steroid refractory colitis1
Case 1: Steroid-Refractory Colitis
  • What diagnostic tests on admission?
slide4

Endoscopic appearance of the severe colitis affecting the rectosigmoid

Hamlin P J et al. Postgrad Med J 2004;80:233-235

case 1 steroid refractory colitis2
Case 1: Steroid-Refractory Colitis
  • After 5 days of hydrocortisone 100 mg Q8h IV, he continues to have in excess of 12 stools a day
  • What are the data regarding CMV as a contributing factor in steroid-refractory ulcerative colitis?
case 1 steroid refractory colitis diagnostic tests for cmv
Case 1: Steroid-Refractory ColitisDiagnostic Tests for CMV

Nguyen M, et al. Ulcers 2011:doi10.1155/2011/282507

slide7
Studies of CMV+ Patients with Steroid-Refractory UC Who Experienced Clinical Response After Addition of Anti-Viral Therapy

Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7

prevalence of cmv in endoscopic colonic biopsies from patients with steroid refractory colitis
Prevalence of CMV in Endoscopic Colonic Biopsies from Patients with Steroid-Refractory Colitis

Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7

cmv infected cell
CMV-infected Cell

Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7