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A simple IBD flare?

1 Mar, 17 | by abhichauhan

33 year old male with ulcerative colitis presents with a 5-day history of fever, night sweats, abdominal pain and increased stool frequency. Medications include mesalazine M/R 1g once daily, 6-mercaptopurine 75mg once daily and a two week course of prednisolone 40mg once daily. Bloods revealed a leukopenia and c-reactive protein of 23. Based on the flexible sigmoidoscopy (figure) findings what is the most likely diagnosis? How would this change your management?

Submitted by Matthew Armstrong, Tom Thomas, Tariq Iqbal, Ralph Boulton and Jason Goh .

Gastroenterology department, University Hospital Birmingham, Birmingham, UK.

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  • Andrew Cole

    looks atypical, worry about CMV, any foreign travel? PCR for CMV and if positive ganciclovir.

  • Akshay Gee

    The flexi shows CMV colitis

  • Manos Skouras

    CMV colitis with an inclusion body on histology.
    Start Ganciclovir.
    If no response stop immunosuppression.

  • J Singh

    interesting case, do we have the baseline cmv status?

  • Nikhil Khera

    stop immunosuppressant therapy – and initiate antiviral with ganciclovir

  • Kishaan Jey

    To what degree is he immunosuppressed? 6TG and 6MMP levels?

  • Akhil Khera

    Continue immunosuppressant however begin antiviral therapy. ?CMV Coltis

  • Jakemann

    Cmv colitis. Stop immunosuppression. Check viral titre on pcr. Gangciclovir

  • Dipal Juthani

    The presentation and the sigmoidoscopy appearance of “punched out ulcers” is typical of CMV colitis. Biopsies should be taken for CMV PCR and patient to be treated with IV ganciclovir alongside current treatment.

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