First Reported Case of Upadacitinib-Associated Cytomegalovirus Viremia and Suspected Pneumonitis in Ulcerative Colitis

Authors

• Wilfredo Jhoel Javier-Rojas, HCA HealthcareFollow
• Alvin Boyd Newman-Caro, HCA HealthcareFollow
• Mamoon Ghellai, HCA HealthcareFollow
• Vamsee Mupparaju, HCA HealthcareFollow
• Sreekanth Chandrupatla, HCA HealthcareFollow
• Siddharth Mathur, HCA HealthcareFollow
• Yizhi Lin, HCA HealthcareFollow

Division

West Florida

Hospital

Blake Medical Center

Document Type

Case Report

Publication Date

4-6-2026

Keywords

CMV, IBD, inflammatory bowel disease, ulcerative colitis, upadacitinib

Disciplines

Digestive System Diseases | Gastroenterology | Internal Medicine | Medicine and Health Sciences | Virus Diseases

Abstract

Cytomegalovirus (CMV) reactivation is a clinically important risk in patients with inflammatory bowel disease, particularly those receiving systemic immunosuppression or Janus kinase (JAK) inhibitor therapy, which can impair immunity. JAK inhibitors, including upadacitinib, may predispose patients to opportunistic viral infections. We report a patient with moderate ulcerative colitis who developed CMV viremia with suspected CMV pneumonitis 4 weeks after starting upadacitinib. Antiviral therapy led to clinical and virologic resolution. This case broadens the spectrum of CMV-related complications associated with JAK inhibition and underscores the importance of maintaining vigilance for systemic viral reactivation in inflammatory bowel disease patients receiving immunosuppressive therapy.

Publisher or Conference

ACG Case Reports Journal

Recommended Citation

Javier-Rojas WJ, Newman-Caro AB, Ghellai M, et al. First Reported Case of Upadacitinib-Associated Cytomegalovirus Viremia and Suspected Pneumonitis in Ulcerative Colitis. ACG Case Rep J. 2026;13(4):e02049. Published 2026 Apr 6. doi:10.14309/crj.0000000000002049