Citomegalovírus na colite ulcerosa: causa ou coincidência?

 I. Rosa¹, A. Queiroz¹, F. Mera², C. Viveiros¹, I. Medeiros¹, L. Gonçalves¹

 

Resumo

A infecção por citomegalovírus em doentes com colite ulcerosa está descrita em menos de 50 casos, mas pode ter implicações clínicas. Enquanto alguns autores consideram o vírus uma causa de exacerbação da doença inflamatória, outros vêem-no como um mero achado. No entanto, o ganciclovir levou a remissão clínica em vários casos publicados.

Os autores descrevem o caso de um homem de 42 anos, internado por diarreia, astenia e edema generalizado. Tratava-se de um alcoólico, sem outras patologias conhecidas, nem evidência laboratorial de imunossupressão. Uma fibrossigmoidoscopia revelou colite activa, com células com inclusões intranucleares. Iniciou-se ganciclovir, com melhoria clínica, mas as biopsias de controlo mostraram colite ulcerosa activa, sem evidência de citomegalovírus. Acrescentou-se à terapêutica mesalazina, com remissão completa do quadro.

 

Summary

Cytomegalovirus infection in patients with ulcerative colitis is described in fewer than 50 cases, but it may have clinical implications. While some authors pose the virus as a cause of exacerbations, others see it as a mere bystander. Nevertheless, ganciclovir therapy led to clinical remission in several published cases.

We report the case of a 42-year-old male admitted for diarrhoea, asthenia and generalized oedema. He was an alcoholic, with no other known disease and no laboratorial evidence of immunosuppression. Flexible sigmoidoscopy revealed an active colitis with cells containing intranuclear inclusions. Ganciclovir therapy was started, with clinical improvement, but biopsies taken 7 days later showed active ulcerative colitis, with no evidence of cytomegalovirus. Mesalazine was added, with complete remission.

 

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(1) Unidade de Gastrenterologia.

(2) Serviço de Anatomia Patológica.

Hospital do Espírito Santo, Évora, Portugal.

 

Recebido para publicação: 20/04/2005

Aceite para publicação: 30/11/2005