CMV pneumonitis in a patient with Crohn’s disease taking azathioprine

2021 ◽  
Vol 14 (4) ◽  
pp. e241256
Author(s):  
Timothy Zef Hawthorne ◽  
Rachel Shellien ◽  
Lucy Chambers ◽  
Graham Devereux
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Low Dose ◽  
Antiviral Treatment ◽  
Cmv Infection ◽  
Rare Presentation ◽  
Intravenous Ganciclovir ◽  
Increased Risk ◽  
Oral Valganciclovir

This case report discusses the rare presentation of cytomegalovirus (CMV) pneumonitis in a young patient with moderately severe Crohn’s disease managed with low dose azathioprine. CMV pneumonitis was initially suspected on CT chest images and confirmed by PCR for CMV. She was treated with intravenous ganciclovir and later stepped down to oral valganciclovir. Although this patient had a prolonged and complicated hospital admission, a good clinical outcome was achieved. CMV infection was raised as an early differential and antiviral treatment was started without delay. This case study, therefore, makes the case for increased awareness of the possibility of, and recognition of CMV pneumonitis among healthcare professionals as a way of preventing significant morbidity and mortality. It also raises awareness of checking for slow metabolisers of azathioprine before initiation to look for individuals who may be at increased risk of azathioprine’s adverse effects.

scholarly journals CMV Ileitis: To Treat or Not to Treat? Implications of Initiating Biologic Therapy for Concurrent Crohn’s Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Kendra T. Stilwell ◽  
Jason Estes ◽  
Maria T. Kurtz ◽  
James M. Francis ◽  
David T. Lynch ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Mortality Rate ◽  
Crohn's Disease ◽  
Medical Literature ◽  
Biologic Therapy ◽  
Antiviral Treatment ◽  
Current Medical ◽  
Spontaneous Resolution ◽  
Cmv Infection ◽  
Current Guidelines

Cytomegalovirus (CMV) enteritis is traditionally thought to be a self-limited infection in immunocompetent individuals. Consequently, current guidelines recommend against treating nonimmunocompromised patients with antiviral therapy. Conversely, recent data suggests that spontaneous resolution occurs less frequently than previously believed; furthermore, mortality rate in immunocompetent individuals is similar to that of the immunosuppressed. We present a case of a 43-year-old male who was simultaneously diagnosed with CMV ileitis and Crohn’s Disease. When discovered concomitantly, there is no guidance in the current medical literature regarding the benefit of antiviral treatment of the CMV infection prior to initiating biologic therapy versus the risks of withholding treatment, as is currently recommended for nonimmunosuppressed individuals.

Su1988 ENVIRONMENTAL EFFECT OF RESOLVED HUMAN CMV INFECTION AND NK RECEPTOR GENETICS IN PEDIATRIC CROHN'S DISEASE SUSCEPTIBILITY AND PHENOTYPE.

2020 ◽  
Vol 158 (6) ◽  
pp. S-735
Author(s):  
Terri Shih ◽  
Susy Yusung ◽  
Dalin Li ◽  
Rivkah Gonsky ◽  
Gregory J. Botwin ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Environmental Effect ◽  
Disease Susceptibility ◽  
Cmv Infection ◽  
Human Cmv ◽  
Nk Receptor

scholarly journals Appendiceal Carcinoids In Crohn’s Disease

2003 ◽  
Vol 17 (1) ◽  
pp. 43-46 ◽  
Author(s):  
Hugh J Freeman
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Carcinoid Tumour ◽  
Intestinal Resection ◽  
Case Review ◽  
Appendiceal Neoplasms ◽  
Increased Risk ◽  
Intestinal Neoplasms ◽  
Resection Specimen ◽  
Sporadic Cases

Earlier investigations demonstrate an increased risk for colon cancer in Crohn's disease. For other intestinal neoplasms, such as carcinoids, studies are limited. In Crohn's disease, repeated endoscopic and imaging studies along with intestinal resections may facilitate clinical recognition of neoplastic diseases, including appendiceal neoplasms. To date, however, only sporadic cases of appendiceal carcinoids have been described in Crohn's disease. In the present study, in a single clinician database of 1000 Crohn's disease patients, three of the 441 patients who had undergone intestinal resection had appendiceal carcinoids, all of which were pathologically confirmed. All were observed in female patients and were not suspected before surgical treatment. In one case, even though management was not altered, the tumour had already invaded serosal fat indicating a potential for more advanced disease. In this series, a carcinoid tumour was found in a resection specimen during a later clinical case review and another was a microcarcinoid, implying that these tumours may be overlooked in Crohn's disease. The percentage detected in the entire database (0.3%) exceeds the reported rates of detection of appendiceal carcinoids after removal of the appendix for appendicitis, as well as the rate of detection of appendiceal carcinoids in autopsy studies. This percentage would be higher if only those having an intestinal resection were considered (0.68%). Additional studies are needed to further define this risk of appendiceal carcinoids in Crohn's disease.

391 OBESITY IS ASSOCIATED WITH INCREASED RISK OF OLDER ONSET CROHN'S DISEASE: RESULTS FROM THE DEFINE-IBD CONSORTIUM

2021 ◽  
Vol 160 (6) ◽  
pp. S-80
Author(s):  
Simon Chan ◽  
Ye Chen ◽  
Kevin Casey ◽  
Ola Olen ◽  
Jonas F. Ludvigsson ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Increased Risk

scholarly journals Low-Dose Computed Tomography for the Optimization of Radiation Dose Exposure in Patients with Crohn’s Disease

2018 ◽  
Vol 2018 ◽  
pp. 1-10 ◽  
Author(s):  
Richard G. Kavanagh ◽  
John O’Grady ◽  
Brian W. Carey ◽  
Patrick D. McLaughlin ◽  
Siobhan B. O’Neill ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Crohn’S Disease ◽  
Image Quality ◽  
Crohn's Disease ◽  
Radiation Dose ◽  
Ionizing Radiation ◽  
Low Dose ◽  
Radiation Doses ◽  
Radiation Dose Exposure ◽  
Ct Technology

Magnetic resonance imaging (MRI) is the mainstay method for the radiological imaging of the small bowel in patients with inflammatory bowel disease without the use of ionizing radiation. There are circumstances where imaging using ionizing radiation is required, particularly in the acute setting. This usually takes the form of computed tomography (CT). There has been a significant increase in the utilization of computed tomography (CT) for patients with Crohn’s disease as patients are frequently diagnosed at a relatively young age and require repeated imaging. Between seven and eleven percent of patients with IBD are exposed to high cumulative effective radiation doses (CEDs) (>35–75 mSv), mostly patients with Crohn’s disease (Newnham E 2007, Levi Z 2009, Hou JK 2014, Estay C 2015). This is primarily due to the more widespread and repeated use of CT, which accounts for 77% of radiation dose exposure amongst patients with Crohn’s disease (Desmond et al., 2008). Reports of the projected cancer risks from the increasing CT use (Berrington et al., 2007) have led to increased patient awareness regarding the potential health risks from ionizing radiation (Coakley et al., 2011). Our responsibilities as physicians caring for these patients include education regarding radiation risk and, when an investigation that utilizes ionizing radiation is required, to keep radiation doses as low as reasonably achievable: the “ALARA” principle. Recent advances in CT technology have facilitated substantial radiation dose reductions in many clinical settings, and several studies have demonstrated significantly decreased radiation doses in Crohn’s disease patients while maintaining diagnostic image quality. However, there is a balance to be struck between reducing radiation exposure and maintaining satisfactory image quality; if radiation dose is reduced excessively, the resulting CT images can be of poor quality and may be nondiagnostic. In this paper, we summarize the available evidence related to imaging of Crohn’s disease, radiation exposure, and risk, and we report recent advances in low-dose CT technology that have particular relevance.

scholarly journals GENDER-RELATED DIFFERENCES IN CLINICAL COURSE OF CROHN’S DISEASE IN AN ASIAN POPULATION: a retrospective cohort review

2014 ◽  
Vol 51 (2) ◽  
pp. 90-96 ◽  
Author(s):  
Siu-tong LAW ◽  
Kin Kong LI
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Immunosuppressive Therapy ◽  
Retrospective Cohort ◽  
Clinical Characteristics ◽  
Positive Family History ◽  
Asian Population ◽  
Smoking History ◽  
Phenotypic Characteristics ◽  
Increased Risk

ContextData from Asian populations about gender-related differences in Crohn’s disease are few.ObjectivesThis study was to analyze the clinical characteristics between women and men affected by Crohn’s disease.MethodsThis was a retrospective cohort study to analyze consecutive Crohn’s disease patients from Jan 2000 to Dec 2012. Clinical and phenotypic characteristics and treatment outcomes were evaluated.Results79 patients (55 male and two of them with positive family history) were diagnosed with Crohn’s disease. Ileocolonic disease and inflammatory lesion was the most dominant site of involvement and disease behavior respectively in both men and women. Apart from higher frequency of nausea (45.83 vs 23.64%, P 0.024) and lower body mass index (19.44 vs 22.03 kg/m2, P 0.003) reported in women, no significant gender-related differences in clinical characteristics were observed. Women were more associated with delay use of immunosuppressive therapy (12 vs 36 months, P = 0.028), particularly for those aged less than 40 years old (85 vs 62.6%,P = 0.023). Cox proportional hazard regression analysis revealed that active smoking (HR, 4.679; 95% CI, 1.03-21.18) and delayed use of immunosuppressive therapy (HR, 4.13; 95% CI, 1.01-16.88) were only independent risk factors associated with increased risk of complications.ConclusionsThere were no significant gender-specific differences in clinical and phenotypic characteristics between male and female Crohn’s disease patients. Smoking history and delay use of immunosuppressive therapy were associated with higher risk of complications.

Low-dose cyclosporin for Crohn's disease: implications for clinical trials

2007 ◽  
Vol 3 (2) ◽  
pp. 135-142 ◽  
Author(s):  
J. BRYNSKOV ◽  
V. BINDER ◽  
P. RIIS ◽  
K. LAURITSEN ◽  
O. SCHAFFALITZKY MUCKADELL ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Low Dose
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