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Surgical pathology revealed quiescent Crohn’s disease with cytomegalovirus colitis, highlighting a discordance between initial endoscopic evaluation and subsequent histopathologic findings.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/rapid-induction-of-remission-with-upadacitinib-followed-by-cytomegalovirus-colitis-in-a-hospitalized-patient-with-crohns-disease/460444/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/rapid-induction-of-remission-with-upadacitinib-followed-by-cytomegalovirus-colitis-in-a-hospitalized-patient-with-crohns-disease/460444.png","ImageObject",300,407,{"name":42,"@type":43},"MrHarris58","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",5,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What treatment was initiated, and how did the patient respond initially?","Question",{"text":63,"@type":64},"Off-label, high-intensity upadacitinib was started. The patient experienced rapid improvement in bloody diarrhea and normalization of CRP after 6 days.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why did the patient ultimately undergo colectomy?",{"text":68,"@type":64},"She developed clinical deterioration despite an initial response, leading to colectomy for suspected refractory Crohn’s disease.",{"name":70,"@type":61,"acceptedAnswer":71},"What did surgical pathology reveal compared with early endoscopic findings?",{"text":72,"@type":64},"Pathology showed quiescent Crohn’s disease with cytomegalovirus colitis, despite no initial endoscopic evidence of infection.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},460444,1790758491,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":55,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":33,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":80,"read_time":123,"preview_page_count":4},687212988360,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","ACG CASE REPORTS JOURNAL   \nCASE REPORT | INFLAMMATORY BOWEL DISEASE  \nRapid Induction of Remission With Upadacitinib Followed by Cytomegalovirus Colitis in a Hospitalized Patient With Crohn’s Disease  \nReid Herran, MD 1 , Samuel Wilcox, MD 1 , Gal Hodish, MPH 1 , Asma Nusrat, MD 1 , Jiaqi Shi, MD, PhD 1 ,  \nAbhishek Satishchandran, MD2 , Rutwik Sharma, MD2 , Shrinivas Bishu, MD, FACG 1 , Syed A. Hassan, MBBS 1 , John Byrn, MD 1 , Andrea Todisco, MD 1 , Haley Mertens, MD 1 , Anastasia Wasylyshyn, MD 1 , Peter D. R. Higgins, MD, PhD 1 , and  \nJeffrey A. Berinstein, MD 1  \n1 University of Michigan, Ann Arbor, MI  \n2 University of Michigan Health-Sparrow, Lansing, MI  \nABSTRACT  \nA 60-year-old woman with acute severe Crohn’s colitis hada rapid initial response to off-label, high-intensity upadacitinib;however, she subsequently demonstrated clinical deterioration ultimately undergoing colectomy for suspected refractory Crohn’s disease. Surgical pathology unexpectedly revealed quiescent Crohn’s disease with cytomegalovirus colitis, despite no initial endoscopic evidence of infection.  \nKEYWORDS: Crohn’s disease; cytomegalovirus; upadacitinib; IBD  \nABBREVIATIONS: CD, Crohn’s disease; CMV, cytomegalovirus; CRP, C-reactive protein; H&E, hematoxylin and eosin; IBD, inflammatory bowel disease; IV, intravenous; MR, magnetic resonance  \nINTRODUCTION  \nCrohn’s disease(CD), a chronic, relapsing inflammatory disorder that can affect any part ofthe gastrointestinal tract, is characterized by bloody diarrhea, abdominal pain, and weight loss and can lead to complications including stricture, fistula, or abscess. Patients with CD who develop severe symptoms or Crohn’s-related complications often require hospitalization for rapid induction of treatment to improve symptoms and prevent progression of complications. There are no clear, disease-specific guidelines for patients hospitalized with Crohn’s; instead, management strategies often focus on addressing specific complications or are extrapolated from protocols established for acute severe ulcerative colitis, particularly when patients present with acute severe Crohn’s colitis. Generally, acute severe ulcerative colitis guidelines recommend initial flexible sigmoidoscopy within 24–72 hours of admission to assess disease severity and to rule out cytomegalovirus (CMV) .1 However, there is no consensus recommendation for second-look endoscopy when clinical status fails to improve or worsens. Escalation to rescue therapy or surgical intervention is based on lack of clinical response after 3–5 days, not on repeat endoscopic findings.1  \nWe present the case of a 60-year-old woman hospitalized with acute severe Crohn’s colitis, who experienced rapid clinical improvement following initiation of upadacitinib followed by clinical deterioration, prompting semiurgent colectomy. Pathology revealed quiescent CD with CMV colitis, despite no initial endoscopic evidence of infection.  \nCASE REPORT  \nA 60-year-old woman with a history of anoxic brain injury and CD (diagnosis previously ulcerative colitis but changed to CD based on discovery of penetrating perianal disease) previously on Lialda, hydrocortisone enemas, and prednisone, presented with uncontrolled rectal pain and bloody diarrhea. Upon arrival, vital signs were stable and labs were notable for hemoglobin 10 g/dL,  \nACG Case Rep J 2026;13:e01961 . doi:10 . 14309/crj.0000000000001961. Published online: January 9, 2026 Correspondence: Reid Herran, MD ([herranre@med.umich.edu](herranre@med.umich.edu)) .  \nACG Case Reports [Journal / Volume 13 acgcasereports.com 1](Journal / Volume 13 acgcasereports.com 1)  \nHerran et al Rapid Induction of Remission With Upadacitinib  \nFigure1.(A)Endoscopy image from initial flexible sigmoidoscopy showing erythematous, edematous, friable, and severely ulcerated mucosa.(B) Endoscopy image from relook colonoscopy with yellow arrow showing healing ulcer. (C) Endoscopy image from relook colonoscopy with yellow arrows showing healin","cbCairVyqhN8enU8","https://ap.wps.com/l/cbCairVyqhN8enU8","pdf",640655,"English","# Abstract\n# Introduction\n# Case Report\n## Initial Presentation and Evaluation\n## Treatment and Clinical Course\n## Endoscopy and Pathology","[{\"question\":\"What treatment was initiated, and how did the patient respond initially?\",\"answer\":\"Off-label, high-intensity upadacitinib was started. The patient experienced rapid improvement in bloody diarrhea and normalization of CRP after 6 days.\"},{\"question\":\"Why did the patient ultimately undergo colectomy?\",\"answer\":\"She developed clinical deterioration despite an initial response, leading to colectomy for suspected refractory Crohn’s disease.\"},{\"question\":\"What did surgical pathology reveal compared with early endoscopic findings?\",\"answer\":\"Pathology showed quiescent Crohn’s disease with cytomegalovirus colitis, despite no initial endoscopic evidence of infection.\"}]","Rapid Induction of Remission With Upadacitinib Followed by Cytomegalovirus Colitis in a Hospitalized Patient With Crohn’s Disease | PDF"]