Cytomegalovirus Pneumonia in Inflammatory Bowel Disease: Literature Review and Clinical Recommendations

Keyu Ren; Chunming Yong; Yanting Wang; Hongyun Wei; Kun Zhao; Baoguo He; Mingjuan Cui; Yunqing Chen; Jin Wang

doi:10.2147/IDR.S420244

Cytomegalovirus Pneumonia in Inflammatory Bowel Disease: Literature Review and Clinical Recommendations

Infect Drug Resist. 2023 Sep 13:16:6195-6208. doi: 10.2147/IDR.S420244. eCollection 2023.

Authors

Keyu Ren¹, Chunming Yong², Yanting Wang¹, Hongyun Wei¹, Kun Zhao¹, Baoguo He¹, Mingjuan Cui¹, Yunqing Chen³, Jin Wang⁴

Affiliations

¹ Department of Gastroenterology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China.
² Department of Emergency, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China.
³ Department of Pathology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266000, People's Republic of China.
⁴ Department of Pathology, School of Basic Medicine, Qingdao University, Qingdao, Shandong, 266000, People's Republic of China.

Abstract

Aim: The objective was to elucidate the correlation between CMVP and immunosuppressive therapy in IBD patients, we hope this review could expand on the significance of CMV as an opportunistic pathogen and the potential impact on morbidity and mortality in IBD patients.

Methods: Records and clinical trajectories linked to CMVP in IBD patients were extracted from the PubMed database, irrespective of language barriers. The reference lists incorporated in these studies were manually inspected. Conclusions were generated using straightforward descriptive analysis.

Results: In total, 18 IBD patients, including Crohn's disease (CD, 67%) and Ulcerative Colitis (UC, 33%), affected by CMVP were identified from 17 published articles. A minority of these patients (17%) exhibited active disease, whereas the majority (83%) presented with quiescent disease. Fever (100%) and dyspnea (44%) emerged as the most prevalent clinical symptoms. All the patients had undergone immunosuppressive therapy. A significant proportion, up to 89%, had received thiopurine treatment prior to the CMVP diagnosis. Interestingly, none of the patients were subjected to biological therapy. Half of the patients manifested with Hemophagocytic Lymphohistiocytosis (HLH). Almost all patients (94%) were administered antiviral treatment and a substantial 83% experienced full recovery. Immunosuppressive agents were either tapered or discontinued altogether. A subset of patients, 17%, suffered fatal outcomes.

Conclusion: Our findings underscore the need for heightened suspicion of CMVP in IBD patients who exhibit symptoms such as fever and dyspnea. During the COVID-19 pandemic, CMVP should be considered a potential differential diagnosis. It was observed that CMVP primarily transpires during CD remission. Azathioprine emerged as the predominant immunosuppressant linked to CMV reactivation. The prompt application of effective antiviral therapy can substantially enhance patient outcomes. CMV vaccine might serve as a viable prevention strategy.

Keywords: CMV; Crohn’s disease; cytomegalovirus pneumonia; inflammatory bowel disease; ulcerative colitis.

Publication types

Review

Grants and funding

This work was supported by the Intramural Research Program of the Affiliated Hospital of Qingdao University [grant number 4020] to Keyu Ren and the Shandong Province Natural Science Foundation [General Program, Grant No. ZR2022MH204] to Jin Wang.