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CMV Colitis — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostCMV ColitisSCE Infectious Diseases

A 60-year-old woman with rheumatoid arthritis on Prednisolone 15 mg daily and Methotrexate develops progressive abdominal pain and bloody diarrhoea. CT shows thickening of the caecum and ascending colon. Stool CMV PCR is positive at 25,000 copies/mL. Colonoscopic biopsies show owl-eye inclusions in endothelial cells. What is the most appropriate management?

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Correct answer: B — IV Ganciclovir 5 mg/kg BD for 21 days and reduce immunosuppression

CMV colitis in an immunosuppressed (non-HIV) patient requires IV Ganciclovir at treatment doses (5 mg/kg BD, adjusted for renal function) for 21 days. Reduction of immunosuppression (particularly corticosteroid dose) is an important adjunct. Oral Valganciclovir may be used for step-down once clinical improvement occurs but is not preferred for initial treatment of tissue-invasive disease. Foscarnet is reserved for Ganciclovir intolerance or resistance.

Reference: NICE NG37 2016 – CMV; ECCO 2023 – Opportunistic infections in IBD/immunosuppression