Case Report
Copyright ©The Author(s) 2005. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 7, 2005; 11(33): 5241-5244
Published online Sep 7, 2005. doi: 10.3748/wjg.v11.i33.5241
Refractory ulcerative colitis accompanied with cytomegalovirus colitis and multiple liver abscesses: A case report
Takuya Inoue, Ichiro Hirata, Yutaro Egashira, Kumi Ishida, Ken Kawakami, Eijiro Morita, Naoko Murano, Shingo Yasumoto, Mitsuyuki Murano, Ken Toshina, Takashi Nishikawa, Norihiro Hamamoto, Ken Nakagawa, Ken-Ichi Katsu
Takuya Inoue, Ichiro Hirata, Kumi Ishida, Ken Kawakami, Eijiro Morita, Naoko Murano, Shingo Yasumoto, Mitsuyuki Murano, Ken Toshina, Takashi Nishikawa, Norihiro Hamamoto, Ken Nakagawa, Ken-Ichi Katsu, The Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigakucho, Takatsuki City, Osaka 569-8686, Japan
Yutaro Egashira, Department of Pathology, Osaka Medical College, Takatsuki City, Osaka 569-8686, Japan
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. Ichiro Hirata, The Second Department of Internal Medicine, Osaka Medical College, 2-7 Daigakucho, Takatsuki City, Osaka 569-8686, Japan. hirata@poh.osaka-med.ac.jp
Telephone: +81-72-684-6532
Received: December 30, 2004
Revised: January 23, 2005
Accepted: January 26, 2005
Published online: September 7, 2005
Abstract

Various hepato-biliary complications are an increased incidence in patients with inflammatory bowel disease, and portal bacteremia is well documented in patients with ulcerative colitis (UC). However, few reports mention UC in association with liver abscesses. Recently, there are several reports describing cytomegalovirus (CMV) infection in association with disease exacerbation and steroid refractoriness in patients with UC. Here we present a case of refractory UC accompanied with multiple liver abscesses and CMV colitis. The patient, a 72-year-old male, with a five-year history of repeated admissions to our hospital for UC, presented with an exacerbation of his UC. Sigmoidoscopy performed on admission suggested that his UC was exacerbated, then he was given prednisolone and mesalazine orally, and betamethasone enemas. However, he had exacerbated symptoms. Repeat sigmoidoscopy revealed multiple longitudinal ulcers and pseudopolyps in the rectosigmoid colon. Although immunohistochemical staining of biopsy specimens and the serum testing for antigenemia were negative on admission and after the repeat sigmoidoscopy, they became histologically positive for CMV. Nonetheless, the patient developed spiking fevers, soon after ganciclovir was administered. Laboratory studies revealed an increased white cell count with left shift, and Enterococcus fecalis grew in blood cultures. An abdominal computed tomography (CT) scan was obtained and the diagnosis of liver abscesses associated with UC was made, based on CT results. The hepatic abscesses were successfully treated with intravenous meropenem for 6 wk, without further percutaneous drainage. To our knowledge, this is the first reported case of multiple liver abscesses that develop during UC exacerbation complicated by CMV colitis.

Keywords: Liver abscess; Ulcerative colitis; Cytomegalovirus infection; Inflammatory bowel disease