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Detection and Treatment of Clostridium Difficile and Enteric Pathogens in IBD Patients

This case study by Dr. David G. Binion and Dr. Bruce E. Sands delves into the complexities of managing steroid-refractory colitis, particularly in a 22-year-old male diagnosed with ulcerative colitis. Despite treatment with high-dose prednisone, the patient continued to experience severe symptoms. Diagnostic challenges arise in identifying complicating factors such as Cytomegalovirus (CMV) infection, which is known to influence treatment outcomes. This study reviews endoscopic findings, relevant diagnostic tests, and the integrative approach to addressing refractory IBD cases.

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Detection and Treatment of Clostridium Difficile and Enteric Pathogens in IBD Patients

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Presentation Transcript

  1. GI tract infections in IBD: Detection and treatment of Clostridium difficile, CMV and enteric pathogens: Case studies David G. Binion, MD Bruce E. Sands, MD, MS

  2. Case 1: Steroid-Refractory Colitis • 22 yo man admitted for severe colitis • Diagnosed with UC at age 17, maintained on mesalamine • Three weeks ago, onset of 8 loose, bloody stools/day with urgency, tenesmus • Began prednisone 40 mg/d 18 days ago • Exam • Afebrile, VSS • Abdomen: active bowel sounds, soft, nontender, no HSM

  3. Case 1: Steroid-Refractory Colitis • What diagnostic tests on admission?

  4. Endoscopic appearance of the severe colitis affecting the rectosigmoid Hamlin P J et al. Postgrad Med J 2004;80:233-235

  5. Case 1: Steroid-Refractory Colitis • After 5 days of hydrocortisone 100 mg Q8h IV, he continues to have in excess of 12 stools a day • What are the data regarding CMV as a contributing factor in steroid-refractory ulcerative colitis?

  6. Case 1: Steroid-Refractory ColitisDiagnostic Tests for CMV Nguyen M, et al. Ulcers 2011:doi10.1155/2011/282507

  7. Studies of CMV+ Patients with Steroid-Refractory UC Who Experienced Clinical Response After Addition of Anti-Viral Therapy Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7

  8. Prevalence of CMV in Endoscopic Colonic Biopsies from Patients with Steroid-Refractory Colitis Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7

  9. CMV-infected Cell Lawlor G, Moss AC. Inflamm Bowel Dis 2010;16:1620-7

  10. CMV-colitis

  11. Ayre K, et al. J Crohn’s Colitis 2009;3:141-8

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