Cytomegalovirus and ulcerative colitis: Place of antiviral therapy

Figure 2 Therapeutic algorithm for the intake of flare-ups of refractory ulcerative colitis in patients aged > 30 years according to the quantification of cytomegalovirus density in colonic tissue. ¹Defined by steroid resistance or immunosuppressive treatment or anti-TNF drugs; ²Defined by quantification of CMV DNA in intestinal tissue of 10-250 copies/mg of inflamed tissue or low-grade CMV density by IHC in biopsy specimens (4 inclusions or less); ³Defined by quantification of CMV DNA in intestinal tissue of > 250 copies/mg of inflamed tissue or high-grade CMV density by IHC in biopsy specimens (more than 4 inclusions); ⁴Defined by a need for hospitalization and a Lichtiger score > 10. CMV: Cytomegalovirus; IHC: immunohistochemistry; TNF: Tumor necrosis factor.