# Prevalence and Diagnostic Challenges of Cytomegalovirus Colitis in Inflammatory Bowel Disease: A Retrospective Study From a Romanian Tertiary Care Center

## TL;DR

This study examines how often cytomegalovirus colitis occurs in inflammatory bowel disease patients and highlights the challenges in diagnosing it.

## Contribution

The study provides insights into the low prevalence of CMV colitis in a specific IBD cohort and emphasizes the limitations of serology in diagnosis.

## Key findings

- Only 5.55% of IBD patients showed evidence of acute CMV infection.
- Just 1.85% of patients were diagnosed with CMV colitis via immunohistochemistry.
- Corticosteroid use was observed in all CMV-infected patients, but the small sample size limits conclusions.

## Abstract

Background and aims: Cytomegalovirus (CMV) colitis is a clinically significant complication in patients with inflammatory bowel disease (IBD), particularly in those with severe or steroid-refractory disease, where it may contribute to adverse outcomes. This study aimed to determine the frequency of acute CMV infection and tissue-confirmed CMV colitis among hospitalized IBD patients who underwent CMV evaluation.

Methods: We conducted a retrospective study including adult patients with IBD hospitalized between April 1, 2024, and December 31, 2024, at the Emergency Clinical County Hospital of Târgu Mureș, Romania. CMV serology (immunoglobulin G (IgG), immunoglobulin M (IgM)), colonoscopy with biopsy, and immunohistochemistry were performed when clinically indicated. Demographic characteristics, clinical presentation, treatment regimens, laboratory parameters, and histopathologic findings were analyzed for all included patients.

Results: 54 IBD patients were evaluated. The mean age was 41 years, and most were male. Crohn's disease was diagnosed in 24 patients (44.44%) and ulcerative colitis in 30 patients (55.56%). Three patients (5.55%) showed evidence of acute CMV infection based on serology. Only one patient (1.85%) was diagnosed with CMV colitis by immunohistochemistry. All patients with evidence of CMV infection had received corticosteroid therapy, although the small number of cases limits interpretation.

Conclusions: CMV colitis was uncommon in this cohort of evaluated patients. Diagnosis primarily relied on histopathologic confirmation, with serology serving only as a limited adjunct. CMV infection should be considered in patients with active or steroid-refractory disease. Observations regarding corticosteroid exposure should be interpreted cautiously and considered hypothesis-generating.