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Emanuele Sinagra, Sara Renna, Filippo Mocciaro, Mirko Olivo, Mario Cottone, Ambrogio Orlando, Early postoperative recurrence of severe crohn's disease, with colonic involvement and associated human cytomegalovirus infection, treated with oral valganciclovir and adalimumab, Inflammatory Bowel Diseases, Volume 17, Issue 6, 1 June 2011, Pages E43–E44, https://doi.org/10.1002/ibd.21685
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To the Editor:
In the natural course of Crohn's disease (CD), postoperative recurrence and opportunistic infections such as human cytomegalovirus (HCMV) infection are two conditions that may lead to a more disabling behavior, despite intensive first-line treatments.1 Early recognition of these conditions may help to manage severe CD by choosing adequate treatments to avoid more severe disease complications. We describe an early postoperative recurrence of severe CD, with colonic involvement and superimposed HCMV infection, treated with oral valganciclovir and adalimumab subcutaneously.
A 52-year-old female patient, affected by a recently diagnosed ileocolonic steroid-dependent CD, was admitted to our department with a history of nonbloody diarrhea and severe weight loss, without abdominal pain or other symptoms of possible intestinal obstruction.
Six months previously she underwent a bowel resection with ileocolonic anastomosis for an intestinal subocclusion due to a stenosis of the ileocecal valve, complicated by pelvic abscess.
On physical examination the patient presented signs of severe malnutrition (body mass index [BMI] 12), without any abdominal tenderness or fever, with a blood pressure of 100/50 mmHg and pulse rate of 80 beats/min. Her Crohn's Disease Activity Index (CDAI) score on admission was 297. Laboratory tests showed neutrophilic leukocytosis, erythrocite sedimentation rate (ESR) of 45 mm/hr, C-reactive protein (CRP) of 7 mg/L (n.v. 0.5 mg/L), and severe hypoalbuminemia (1.7 g/dL).
