Cytomegalovirus Colitis during Budesonide Therapy for Ulcerative Colitis
Abstract
Budesonide is recommended for mild-to-moderate ulcerative colitis (UC); however, cytomegalovirus (CMV) colitis may still emerge during therapy. We report the case of a 69-year-old woman with left-sided UC who developed worsening diarrhea and hematochezia while receiving budesonide rectal foam and MMX. Colonoscopy revealed longitudinal, undermined, and "double-tracked" ulcers in the rectosigmoid. CMV pp65 antigenemia was positive, and immunohistochemical staining of a biopsy specimen revealed CMV-infected cells. Oral valganciclovir was initiated, leading to rapid improvement, with antigenemia converting to negative; follow-up endoscopy showed shallower ulcers. This case illustrates that locally acting budesonide MMX does not eliminate the risk of CMV colitis, and viral reactivation can occur even during its use. Accordingly, when clinical worsening occurs during budesonide MMX therapy, early CMV testing should be considered to avoid unnecessary escalation to systemic corticosteroids or advanced agents.
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BibTeX
@article{tamazawa2026cytomegalovirus,
title = {{Cytomegalovirus Colitis during Budesonide Therapy for Ulcerative Colitis}},
author = {Kana Tamazawa and Masato Aizawa and Jun Wada and Natsuki Ishizaki and Kohei Suzuki and Kakeru Otomo and Tadayuki Takagi and Kazutomo Togashi and Hiromasa Ohira},
journal = {Internal Medicine},
year = {2026},
month = aug,
doi = {10.2169/internalmedicine.6614-25},
url = {https://www.jstage.jst.go.jp/article/internalmedicine/65/16/65_6614-25/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Cytomegalovirus Colitis during Budesonide Therapy for Ulcerative Colitis
AU - Kana Tamazawa
AU - Masato Aizawa
AU - Jun Wada
AU - Natsuki Ishizaki
AU - Kohei Suzuki
AU - Kakeru Otomo
AU - Tadayuki Takagi
AU - Kazutomo Togashi
AU - Hiromasa Ohira
PY - 2026
DA - 2026/08/15
JO - Internal Medicine
DO - 10.2169/internalmedicine.6614-25
UR - https://www.jstage.jst.go.jp/article/internalmedicine/65/16/65_6614-25/_article
AB - Budesonide is recommended for mild-to-moderate ulcerative colitis (UC); however, cytomegalovirus (CMV) colitis may still emerge during therapy. We report the case of a 69-year-old woman with left-sided UC who developed worsening diarrhea and hematochezia while receiving budesonide rectal foam and MMX. Colonoscopy revealed longitudinal, undermined, and "double-tracked" ulcers in the rectosigmoid. CMV pp65 antigenemia was positive, and immunohistochemical staining of a biopsy specimen revealed CMV-infected cells. Oral valganciclovir was initiated, leading to rapid improvement, with antigenemia converting to negative; follow-up endoscopy showed shallower ulcers. This case illustrates that locally acting budesonide MMX does not eliminate the risk of CMV colitis, and viral reactivation can occur even during its use. Accordingly, when clinical worsening occurs during budesonide MMX therapy, early CMV testing should be considered to avoid unnecessary escalation to systemic corticosteroids or advanced agents.
SN - 1349-7235
SN - 0918-2918
ER -