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Papaverine adjuvant therapy for microcirculatory disturbance in severe ulcerative colitis complicated with CMV infection: a case report.
- Source :
-
Clinical journal of gastroenterology [Clin J Gastroenterol] 2019 Oct; Vol. 12 (5), pp. 407-413. Date of Electronic Publication: 2019 Apr 03. - Publication Year :
- 2019
-
Abstract
- Ulcerative colitis has hypercoagulable state and high risk of thrombosis; so mucosal disturbance of microcirculation may be mediate and amplify the inflammation of ulcerative colitis. A 56-year-old female patient was admitted in hospital for discontinuously mucous bloody stool for more than 1 year. Ulcerative colitis was determined after colonoscopy and pathologic examination. Mesalazine was effective during the year, but her symptoms recurred three times due to her bad compliance. One month before admission, the patient had severe recurrence after mesalazine withdrawal. At this time, the result of quantitative fluorescence PCR of colonic histic CMV-DNA was 1.6 × 10 <superscript>4</superscript>  copies/mL positive, CMV colitis was accompanied. After 4 weeks of ganciclovir and 6 weeks of mesalazine usage and nutrition support, the symptoms of diarrhea and abdominal cramp did not improve; stool frequency was more than twenty times a day. Probe-based confocal laser endomicroscopy revealed local microcirculation disturbance. Papaverine 90-mg slow drip for at least 10 h a day was added. The symptoms dramatically disappeared after 3 days of papaverine treatment. The patient had yellow mushy stool 2-3 times a day. Pathological findings showed diffuse submucosal hemorrhage and transparent thrombosis in capillaries. Treatment of microcirculatory disturbance in severe UC is a promising adjuvant therapy. Confocal laser endomicroscopy may be an effective method for microcirculation judgment.
- Subjects :
- Colitis, Ulcerative complications
Colitis, Ulcerative pathology
Colitis, Ulcerative physiopathology
Colon blood supply
Colon pathology
Colonoscopy
Cytomegalovirus Infections pathology
Cytomegalovirus Infections physiopathology
Female
Humans
Intestinal Mucosa blood supply
Intestinal Mucosa pathology
Microcirculation drug effects
Microscopy, Confocal
Middle Aged
Colitis, Ulcerative drug therapy
Cytomegalovirus Infections complications
Papaverine therapeutic use
Vasodilator Agents therapeutic use
Subjects
Details
- Language :
- English
- ISSN :
- 1865-7265
- Volume :
- 12
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Clinical journal of gastroenterology
- Publication Type :
- Academic Journal
- Accession number :
- 30945123
- Full Text :
- https://doi.org/10.1007/s12328-019-00974-y