Diffuse gastroduodenitis and enteritis associated with ulcerative colitis and concomitant cytomegalovirus reactivation after total colectomy: report of a case

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• 作者：Motoi Uchino (1)
  Hiroki Ikeuchi (1)
  Toshihiro Bando (1)
  Hiroki Matsuoka (1)
  Akihiro Hirata (1)
  Yoshiko Takahashi (2)
  Yoshio Takesue (2)
  Satoko Inoue (3)
  Naohiro Tomita (1)
  
• 关键词：Ulcerative colitis ; Gastroduodenitis ; Cytomegalovirus ; Pyoderma gangrenosum
• 刊名：Surgery Today
• 出版年：2013
• 出版时间：March 2013
• 年：2013
• 卷：43
• 期：3
• 页码：321-324
• 全文大小：412KB
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• 作者单位：Motoi Uchino (1)
  Hiroki Ikeuchi (1)
  Toshihiro Bando (1)
  Hiroki Matsuoka (1)
  Akihiro Hirata (1)
  Yoshiko Takahashi (2)
  Yoshio Takesue (2)
  Satoko Inoue (3)
  Naohiro Tomita (1)
  
  1. Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
  2. Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
  3. Department of Internal Medicine, Kobe City Medical Centre General Hospital, 2-1-1 Minatojima minami-cho, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
  
• ISSN：1436-2813

文摘

We report a rare case of peristomal pyoderma gangrenosum with severe gastroduodenal lesions, developing after total colectomy in a patient with ulcerative colitis and concomitant cytomegalovirus (CMV) enteritis. A 19-year-old man underwent total proctocolectomy with an ileal J-pouch anal anastomosis and diverting ileostomy, after 2?years of ineffective medical treatment. On postoperative day 6, severe peristomal pyoderma gangrenosum developed and progressed rapidly. Maintaining immunosuppressive therapy with corticosteroids for 6?days induced melena from the gastroduodenal lesions and enteritis with concomitant CMV reactivation. The patient required a jejunostomy, after the duodenal and intestinal CMV lesions had caused multiple perforations. Treatment with intensive cytapheresis was ineffective against the associated UC lesions, which healed with infliximab induction. The CMV reactivation was treated effectively with ganciclovir. The patient is being maintained on infliximab every 8?weeks and there has been no sign of recurrence of the gastroduodenitis-associated UC and CMV reactivation.