Journal
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
Volume 14, Issue 12, Pages 1393-1395Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/00042737-200212000-00018
Keywords
CMV infection; Crohn's disease; vasculitis; multiple organ disease
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This case report describes a 63-year-old woman with a 15-year history of Crohn's disease. After a severe relapse with colitis she was treated with immunosuppressive agents, including an increased dosage of corticosteroids, azathioprine and a single dose of infliximab (anti-tumour necrosis factor-alpha). This led to a brief improvement, which was followed by worsening diarrhoea, fever and skin lesions. Biopsies from upper and lower endoscopies and from an ulcerative skin lesion revealed cytomegalovirus vasculitis in all the tissues removed. The patient improved slowly by withdrawal of the immunosuppressives and with anti-viral therapy. Whenever patients with inflammatory bowel disease deteriorate rapidly, cytomegalovirus infection should be ruled out before the immunosuppressive therapy is fortified.
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