Potential role of upadacitinib in cytomegalovirus colitis recurrence

Kaito Tsujinaka

Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan; Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

Marina Kannno

Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan

Atsushi Ogawa

Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan

Kei Kawada

Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan; Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan

Mitsuhiro Goda

Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan; Department of Clinical Pharmacology and Therapeutics, Graduate School of Biomedical and Heath Sciences, Hiroshima University, Hiroshima, Japan

Hisanori Uehara

Department of Diagnostic Pathology, Tokushima University Hospital, Tokushima, Japan

Keisuke Ishizawa

Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan; Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan; Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, Tokushima, Japan

Keywords

Cytomegalovirus colitis, upadacitinib, JAK inhibitors, ulcerative colitis

Abstract

Background: Cytomegalovirus (CMV) colitis is a common complication in patients with ulcerative colitis (UC), which is often associated with immunosuppressive therapies including steroids, azathioprine, and biologics such as infliximab. Although CMV infections related to upadacitinib, a Janus kinase (JAK) inhibitor, have been reported, they typically occur after prolonged use. Consequently, early onset CMV colitis following the initiation of JAK inhibitors has not been extensively recognised.
Case report: We present the case of a 68-year-old Japanese woman with refractory UC who developed CMV colitis that initially improved but worsened shortly after starting upadacitinib. The patient improved following upadacitinib discontinuation and CMV-specific treatment. This case suggests that early onset CMV colitis after upadacitinib initiation is clinically significant and highlights the importance of monitoring lymphocyte counts and CMV antigen levels during JAK inhibitor therapy.
Conclusion: These findings provide valuable insights into the early risk of CMV reactivation and may guide future management strategies for patients with UC undergoing JAK inhibitor treatment.

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Published: 2025-04-18
Issue: 2025: Vol 12 No 5 (view)

How to cite:
1.
Tsujinaka K, Kannno M, Ogawa A, Kawada K, Goda M, Uehara H, et al. Potential role of upadacitinib in cytomegalovirus colitis recurrence. EJCRIM [Internet]. 2025 Apr. 18 [cited 2025 Jun. 26];12(5). Available from: https://www.ejcrim.com/index.php/EJCRIM/article/view/5309
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