Severe Complication of Thiopurine Treatment in a Young Woman with Crohn’s Disease
  • Michiel PJ Voet
    Department of Internal Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
  • TGA Calon
    Department of Internal Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
  • MMC Hendriks
    Department of Internal Medicine, Catharina Ziekenhuis, Eindhoven, The Netherlands
  • RM Schreuder
    Department of Gastroenterology and Hepatology, Catharina Ziekenhuis, Eindhoven, The Netherlands

Keywords

Cytomegalovirus, thiopurine, pneumonitis, colitis, hepatitis

Abstract

Case Description: TA 28-year old woman receiving thiopurine treatment for Crohn’s disease presented with a systemic primo cytomegalovirus (CMV) infection affecting the gut (colitis), liver (hepatitis), lungs (pneumonitis) and eyes (retinitis). Secondary to this systemic infection, she developed splenomegaly, pancytopenia and lymphadenopathy. Anti-viral treatment resulted in complete resolution of clinical, biochemical and radiological abnormalities within 6 weeks. 
Conclusion: Early recognition is crucial since CMV infection in a patient receiving thiopurine treatment may result in serious complications.

VIEW THE ENTIRE ARTICLE

References

  • Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Rev Med Virol 2010;20:202–213.
  • Gomollón F, Dignass A, Annese V, Tilg H, Van Assche G, Lindsay JO, et al. 3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016: Part 1: Diagnosis and medical management. J Crohn’s Colitis 2017;11:3–25.
  • Richtlijn diagnostiek en behandeling van inflammatoire darmziekten bij volwassenen. Haarlem: The Netherlands: Nederlandse Vereniging van Maag-Darm-Leverartsen; 2008.
  • Papadakis KA, Tung JK, Binder SW, Kam LY, Abreu MT, Targan SR, et al. Outcome of cytomegalovirus infections in patients with inflammatory bowel disease. Am J Gastroenterol 2001;96:2137–2142.
  • Kandiel A, Lashner B. Cytomegalovirus colitis complicating inflammatory bowel disease. Am J Gastroenterol 2006;101:2857–2865.
  • Rafailidis PI, Mourtzoukou EG, Varbobitis IC, Falagas ME. Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 2008;5:1–7.
  • Shukla T, Singh S, Tandon P, McCurdy JD. Corticosteroids and thiopurines, but not tumor necrosis factor antagonists, are associated with cytomegalovirus reactivation in inflammatory bowel disease. J Clin Gastroenterol 2017;51(5):394–401.
  • Cascio A, Iaria C, Ruggeri P, Fries W. Cytomegalovirus pneumonia in patients with inflammatory bowel disease: a systematic review. Int J Infect Dis 2012;16:e474–e479.
  • Beaugerie L, Brousse N, Bouvier AM, Colombel JF, Lémann M, Cosnes J, et al. Lymphoproliferative disorders in patients receiving thiopurines for inflammatory bowel disease: a prospective observational cohort study. Lancet 2009;374:1617–1625.
  • Lum EL, Schaenman JM, DiNicola M, Reddy UG, Shen JI, Pullarkat ST. A case report of CMV lymphadenitis in an adult kidney transplant recipient. Transpl Proc 2015;47:141–145.
  • Rahier JF, Ben-Horin S, Chowers Y, Conlon C, De Munter P, D'Haens G, et al. European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohn’s Colitis 2009;3:47–91.
  • Biank VF, Sheth MK, Talano J, Margolis D, Simpson P, Kugathasan S, et al. Association of Crohn’s disease, thiopurines and primary EBV infection with hemophagocytic lymphohistiocytosis. J Pediatr 2011;159:808–812.
  • Van Langenberg DR, Morrison G, Foley A, Buttigieg RJ, Gibson PR. Cytomegalovirus disease, haemophagocytic syndrome, immunosuppression in patients with IBD: ‘A cocktail best avoided, not stirred’. J Crohn’s Colitis 2011;5:469–472.
  • Abreu C, Sarmento A, Magro F. Screening, prophylaxis and counselling before the start of biological therapies: a practical approach focused on IBD patients. Dig Liver Dis 2017;49:1289–1297.
  • Views: 572
    HTML downloads: 73
    PDF downloads: 334


    Published: 2021-03-29
    Issue: 2021: Vol 8 No 3 (view)


    How to cite:
    1.
    Voet MP, Calon T, Hendriks M, Schreuder R. Severe Complication of Thiopurine Treatment in a Young Woman with Crohn’s Disease. EJCRIM 2021;8 doi:10.12890/2021_002350.