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

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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  1. 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

  2. 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

  3. Case 1: Steroid-Refractory Colitis • What diagnostic tests on admission?

  4. Endoscopic appearance of the severe colitis affecting the rectosigmoid Hamlin P J et al. Postgrad Med J 2004;80:233-235

  5. 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?

  6. Case 1: Steroid-Refractory ColitisDiagnostic Tests for CMV Nguyen M, et al. Ulcers 2011:doi10.1155/2011/282507

  7. 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

  8. Prevalence of CMV in Endoscopic Colonic Biopsies from Patients with Steroid-Refractory Colitis Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7

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

  10. CMV-colitis

  11. Ayre K, et al. J Crohn’s Colitis 2009;3:141-8

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