Introduction: With the routine implementation of blood CMV PCR tests, rapidly changing information regarding the activation of this latent infection has led to the development of various preventive strategies, especially during the first year post-transplantation, known as a high-risk period. Over the years, the predictive value of CMV DNAemia for diagnosis of end organ disease particularly in gastrointestinal involvements, has become a subject of debate. Therefore, defining and deciding on the treatment duration in end organ disease has become challenging in this patient group. In this case series, demographic data of 11 patients diagnosed with CMV colitis through pathology, as well as findings that may be relevant for diagnosis and treatment, are shared.
Method: We conducted a retrospective study of patients with CMV colitis diagnosis through pathology at Baskent University Hospital (Ankara, Turkey) from November 2014 to January 2024. Patient data were obtained from medical records. Inclusion criteria comprised SOT patients who had a pathology diagnosis for CMV colitis. In case of repeated positive results, the first time patient was diagnosed was included. We  evaluated  laboratory  ,colonoscopic, endoscopic,  pathological findings and included other information about the patients that may be relevant for diagnosis and treatment.
Results: Our case series included 11 patients. All of them were renal transplant recipients and had pathology diagnoses of CMV colitis. The mean age was  47.7. Six of our patients were male (54%). The average diagnosis of CMV colitis was 1932 days after transplantation. While 4 patients were diagnosed in less than 200 days, it was noteworthy that 5 patients were diagnosed after 5 years. 8 patients had viremia at the time of pathology diagnosis, while 3 patients did not have viremia. The average viral load was 8479 IU/ml. The highest viral load was observed in the 4th case, which was 40,400 IU/ml. Among the 8 cases with viremia, in 5 of them, when viremia was checked during follow-up, negativity was observed after 1 week of treatment in 1 patient,  2 weeks of treatment in 2 patients and 1 month of treatment in 2 patients. Viremia was not checked in the follow-up of 3 patients. All but one of the patients were treated with gansiclovir, valgansiclovir or both for various durations. Relapse was observed in 4 patients after treatment. Three of them were colitis relapses, while one was a viremia relapse. Five patients had rejection treatment in the 6 months before CMV colitis. Three patients had concurrent infections. The 6-month survival after the diagnosis of CMV colitis was 72%.
Conclusion: Known as an opportunistic infection, CMV is expected to occur particularly in the first year after transplantation, while in our study, the median onset time was 1932 days. Only five patients had recently received rejection treatment. The development of the disease in other patients without any known predisposing condition was noteworthy.