{"id":1767,"date":"2004-10-01T01:00:00","date_gmt":"2004-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/colite-severe-a-cytomegalovirus-complication-rare-des-rectocolites-ulcero-hemorragiques\/"},"modified":"2018-10-20T18:39:34","modified_gmt":"2018-10-20T16:39:34","slug":"colite-severe-a-cytomegalovirus-complication-rare-des-rectocolites-ulcero-hemorragiques","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/colite-severe-a-cytomegalovirus-complication-rare-des-rectocolites-ulcero-hemorragiques\/","title":{"rendered":"Colite s\u00e9v\u00e8re \u00e0 Cytom\u00e9galovirus, complication \u00a0\u00bb rare \u00a0\u00bb des Rectocolites Ulc\u00e9ro H\u00e9morragiques ?"},"content":{"rendered":"

2004<\/strong><\/p>\n

Jean-Marc Maisin, Jean Pierre Chami, Michael Schapira, Jean Michel Ghilain, Jean Henrion
\nH\u00f4pital de Jolimont, 7100 Haine-St-Paul, Belgique<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02004-06-10 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Le diagnostic d’une surinfection colique par le cytom\u00e9galovirus (CMV) chez les patients pr\u00e9sentant une colite ulc\u00e9reuse n’est pas ais\u00e9e par la r\u00e9alisations de biopsies coliques . Cette complication grave est cependant loin d’\u00eatre rare et est surtout observ\u00e9e chez les patients pr\u00e9sentant une colite corticod\u00e9pendante. Le diagnostic rapide par le dosage de l’antig\u00e8ne viral s\u00e9rique est donc important chez ces patients souvent immunod\u00e9prim\u00e9s. Le traitement anti viral pr\u00e9coce permet d’\u00e9viter dans un certain nombre de cas une colectomie. Nous rapportons le cas d’une colite s\u00e9v\u00e8re \u00e0 cytom\u00e9galovirus avec atteinte syst\u00e9mique chez une patiente atteinte de rectocolite ulc\u00e9reuse. Puis nous ferons une revue de la litt\u00e9rature de la pr\u00e9valence, du traitement et du pronostique des colites \u00e0 CMV dans les colites ulc\u00e9reuses. <\/p>\n

Observation: La patiente ag\u00e9e 39 ans est hospitalis\u00e9e dans notre institution en urgence le 12 f\u00e9vrier 2004 pour une diarrh\u00e9e sanglante (15-20 fois\/j) associ\u00e9e \u00e0 des douleurs abdominales. Une colite ulc\u00e9reuse gauche confirm\u00e9e \u00e0 l’histologie et \u00e9voluant depuis 1985 \u00e9tait d\u00e9j\u00e0 connue. Elle a eu plusieurs crises de coliques n\u00e9pr\u00e9tiques. Le traitement d\u00e9but\u00e9 depuis plusieurs ann\u00e9es comprend de l’Azathioprine \u00e0 la dose de 150 mg\/j ; du 5-ASA 3 fois 1 gr\/j; du Colifoam 1\/j; de la M\u00e9thylprednisolone 16 mg\/j; du Buscopan 10 mg ; de l’om\u00e9prazole 20 mg\/j. L’examen clinique montrait une sensibilit\u00e9 du flanc gauche et de l’hypochondre gauche mais sans d\u00e9fense, le transit \u00e9tait pr\u00e9sent. Son poids \u00e9tait de 64Kg et elle \u00e9tait af\u00e9brile. L’ASP ne montrait pas de colectasie. La prise de sang montrait un syndrome inflammatoire avec une augmentation des globules blancs mais sans autre anomalie particuli\u00e8re. Une rectosigmoidoscopie montrait une colite ulc\u00e9reuse avec des ulc\u00e9rations profon!
\ndes d\u00e8s le rectum et sur les 20 cm examin\u00e9s. A l’histologie l’on retrouvait des signes de colite ulc\u00e9reuse s\u00e9v\u00e8re en pouss\u00e9e aigu\u00eb. Les coprocultures sont rest\u00e9es st\u00e9riles; Le scanner abdominal montrait une colite diffuse du rectum remontant jusqu’\u00e0 l’angle gauche sans complication. Le traitement \u00e0 l\u2019admission a consist\u00e9 en un r\u00e9gime sans r\u00e9sidus, une corticoth\u00e9rapie IV \u00e0 125 mg de M\u00e9thylprednisone; 5-ASA 4 fois 1gr; Imuran 150mg. Apr\u00e8s une am\u00e9lioration transitoire de 5 jours, les diarrh\u00e9es sanglantes r\u00e9cidivaient et le syndrome inflammatoire r\u00e9augmentait. Une nouvelle rectosigmoidoscopie montrait l’absence d’am\u00e9lioration des l\u00e9sions. Un traitement par Cyclosporine IV \u00e9tait d\u00e9but\u00e9 le jour m\u00eame. Le soir elle pr\u00e9sentait un \u00e9tat f\u00e9brile (38.8\u00b0C) avec une accentuation des douleurs abdominales. Un nouveau scanner abdominal \u00e9tait r\u00e9alis\u00e9 ne montrant pas d’aggravation des images pr\u00e9c\u00e9dentes. La prise de sang montrait l’apparition d’une cholestase GGT 440 (<50), Ph. Alcaline 853 (<3!
\n00) et d'une cytolyse ASAT 177 (<41), ALAT 144(45) avec une leucop\u00e9nie (2200) et une hypoplaquettose (95.000). L'ensemble des cultures sont revenues n\u00e9gatives. Un traitement empirique a \u00e9t\u00e9 introduit en IV avec du Tazocin (Pip\u00e9racilline + Tazobactam) et du Diflucan (Fluconazole). La T\u00b0 persistait entre 38-39.5\u00b0C. La Cyclosporine \u00e9tait stopp\u00e9e et toutes les s\u00e9rologies virales ont \u00e9t\u00e9 pr\u00e9lev\u00e9es. La seule s\u00e9rologie revenue positive \u00e9tait le CMV IGM (+) et l'IGG 1\/320. L'Ag viral s\u00e9rique (CMV) \u00e9tait demand\u00e9 et est revenu positif. Une PCR pour le CMV est revenue tr\u00e8s \u00e9lev\u00e9e \u00e0 34958 copies\/ml. De nouvelles biopsies rectales furent r\u00e9alis\u00e9es et r\u00e9v\u00e9laient cette fois la pr\u00e9sence du CMV \u00e0 l'examen direct et \u00e0 l'Immunohistochimie. Les antibiotiques furent arr\u00eat\u00e9s et la Ganciclovire fut d\u00e9but\u00e9e en IV pendant 14 jours. L'\u00e9volution fut lentement favorable avec une disparition compl\u00e8te des diarrh\u00e9es, des douleurs abdominales et normalisation de toute la biologie. L'Ag CMV !
\ns\u00e9rique s'est n\u00e9gativ\u00e9 et la PCR aussi. Une coloscopie compl\u00e8te fut r\u00e9alis\u00e9e 1 mois apr\u00e8s la fin du traitement et a objectiv\u00e9 une gu\u00e9rison de tous les ulc\u00e8res. Les biopsies n'ont plus montr\u00e9 de CMV. <\/p>\n

Discussion: La Colite li\u00e9e au CMV est une complication connue mais rare des colites ulc\u00e9reuses. Plusieurs \u00e9tudes prospectives r\u00e9centes ont montr\u00e9 que la pr\u00e9valence d'une surinfection par le CMV de colite ulc\u00e9r\u00e9e en pouss\u00e9e s\u00e9v\u00e8re \u00e0 mod\u00e9r\u00e9e est de 25-34%. Le diagnostic du CMV doit combiner plusieurs m\u00e9thodes car les biopsies seules m\u00eame avec le marquage immunohistochimique ne sont positives que dans moins d'1 cas sur 2. Il faut en outre rechercher l'Ag IGM, l'Ag viral s\u00e9rique et faire un dosage quantitatif par PCR. Une colite \u00e0 CMV est observ\u00e9e essentiellement chez les patients pr\u00e9sentant une corticod\u00e9pendance ou une corticor\u00e9sistance. Le traitement pr\u00e9coce par gancilovire permet de "sauver" des colons. Selon certaines \u00e9tudes les auteurs ont pu obtenir 66.7% de r\u00e9mission apr\u00e8s le traitement. Cependant la surinfection par le CMV reste de mauvais pronostic car outre une morbidit\u00e9 et une mortalit\u00e9 non n\u00e9gligeable, une colectomie est souvent n\u00e9cessaire dans plus 1\/3 des cas. <\/p>\n

En Conclusion: Chez tout patient pr\u00e9sentant une colite ulc\u00e9reuse en pouss\u00e9e s\u00e9v\u00e8re, surtout s'il est corticod\u00e9pendant, une recherche syst\u00e9matique du CMV doit \u00eatre r\u00e9alis\u00e9e, non seulement par biopsies mais surtout par la recherche de l'Ag s\u00e9rique du CMV. Un traitement rapide et ad\u00e9quat par un antiviral permet d'\u00e9viter dans pr\u00e8s de 2\/3 des cas une colectomie.
\nR\u00e9f\u00e9rences :
\n1) Intractable Ulcerative Colitis caused by Cytom\u00e9galovirus infection. Yoko Wada et al. Dis. Colon Rectum 2003 Oct ;46 :S59-65
\n2)Prevalence of Cytomegalovirus infection in IBD patients. Dis Colon Rectum.2004 Mars 25
\n3) Refractory Ulcerative Colitis complicated by a CMV requiring surgery : report of a case. Surg today.2004;34(1):68-71
\n4)Syst\u00e9mic Cytom\u00e9galovirus infection complicating ulcerative colitis: a case report and review of literature. Postgrad Med J 2004;80:233-235
\n5) CMV infection in severe refractory ulcerative and Crohn\u2019s colitis. Am J Gastroenterol 2001; 96:3464-5
\n6) Outcome of Cytomegalovirus infection in patients with IBD Am J Gastroenterol 2001; 96:2137-42<\/p>\n","protected":false},"excerpt":{"rendered":"

2004 Jean-Marc Maisin, Jean Pierre Chami, Michael Schapira, Jean Michel Ghilain, Jean Henrion H\u00f4pital de Jolimont, 7100 Haine-St-Paul, Belgique Gastroent\u00e9rologie – \u00a02004-06-10 –\u00a0CO – ________________________________ Le diagnostic d’une surinfection colique par le cytom\u00e9galovirus (CMV) chez les patients pr\u00e9sentant une colite ulc\u00e9reuse n’est pas ais\u00e9e par la r\u00e9alisations de biopsies coliques . Cette complication grave est […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[15],"class_list":["post-1767","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-15"],"yoast_head":"\nColite s\u00e9v\u00e8re \u00e0 Cytom\u00e9galovirus, complication " rare " des Rectocolites Ulc\u00e9ro H\u00e9morragiques ? - Abstracts des congr\u00e8s de l'ANGH<\/title>\n<meta name=\"description\" content=\"ANGH R\u00e9sum\u00e9s congr\u00e8s H\u00e9patologie Gastroent\u00e9romogie Hepatology Gastroenterology Etudes cliniques Clinical study\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/angh.net\/abstracts\/colite-severe-a-cytomegalovirus-complication-rare-des-rectocolites-ulcero-hemorragiques\/\" \/>\n<meta property=\"og:locale\" content=\"fr_FR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Colite s\u00e9v\u00e8re \u00e0 Cytom\u00e9galovirus, complication " rare " des Rectocolites Ulc\u00e9ro H\u00e9morragiques ? 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