Clinical characteristics and therapy exploration of active human cytomegalovirus infection in 105 lupus patients

Abstract

Systemic lupus erythematosus (SLE) has protean clinical manifestations of varying severity over the course of its onset, exacerbation, remission and flare that could often pose significant challenges for clinicians in their decision making as to whether to treat aggressively or to look for concurrent conditions such as infection with opportunistic pathogens. Human cytomegalovirus (HCMV) is one of those pathogens and is frequently encountered in our daily management of lupus patients. To investigate the clinical characteristics and therapeutic options of active HCMV infection in patients with SLE, we retrospectively reviewed clinical data of 105 inpatients in our department of Rheumatology and Clinical Immunology of Peking Union Medical College Hospital (PUMCH) diagnosed with both SLE and active HCMV infection from January 2006 to January 2012. Three groups were designated that included 42 cases of HCMV triggering SLE, 31 cases of HCMV exacerbating SLE, and 32 cases of HCMV mimicking SLE flare based on the relationship of HCMV infection and SLE. 1) Hematocytopenia (81%), fever (73.3%) and liver dysfunction (54.3%) were the most common clinical manifestations. The differences among the three groups with regard to butterfly erythema, cutaneous vasculitis, arthritis, serositis, central nervous system involvement and renal involvement were statistically significant (p < 0.05). 2) Positive rate of HCMV-pp65, compared with HCMV-IgM and HCMV-DNA, was the highest (84.9%) in patients with SLE and active HCMV infection. 3) Following 14-21 days of inductive treatment with ganciclovir, a total of 26 out of 56 patients were still positive with HCMV-IgM (nine of 19, 47.6%) and pp65 (17/37, 45.9%). Among them, seven cases suffered HCMV relapses in three months with six cases of sustained HCMV-pp65 antigenemia. In conclusion, hematocytopenia, fever and liver dysfunction should remind us to consider HCMV infection. Butterfly erythema, cutaneous vasculitis, arthritis, serositis, central nervous system involvement and renal lesion were relatively characteristic symptoms of lupus activity. HCMV-pp65 is a sensitive indicator to guide antiviral therapy. Induction therapy using ganciclovir with a duration of 14∼21 days is not sufficient, and continued HCMV-pp65 positivity may require prolonged antiviral treatment in lupus patients.

Incidence of Cytomegalovirus Antigenemia in patients with autoimmune rheumatic diseases: a 3-year retrospective study

“…However, it is important to state the possibility of pneumonia caused by multiple microbial agents. Cytopenia had the second place in frequency (40.9%), unlike recent retrospective report of 105 patients with SLE and active CMV infection related 81% of patients with some cytopenia [23]. The simultaneous involvement of various organs can also occur in immunosuppressed patients and was observed in 3 (13.6%) of our patients.…”

Elevated antinuclear antibodies and altered anti-Epstein-Barr virus immune responses

“…Indeed a recent study suggested that a 2-3 weeks treatment with valganciclovir was moderately successful in SLE treatment and that a longer therapy with these compounds might be more beneficial (Zhang et al, 2014). Conversely, mycophenolate motefil, a compound often included in SLE therapy, has been shown to potentiate antiherpesvirus drugs (Neyts et al, 1998).…”

Transalkylation of Higher Trifluoromethylated Fullerenes with C70: A Pathway to New Addition Patterns of C70(CF3)8

“…For example, viral cultures waste time and energy 11, and nucleic acid testing requires special equipment and high costs 12, 13. Furthermore, antibody testing is unsatisfactory because the CMV antibody has a short lifetime and interferences in the tests 14, 15. The CMV pp65 antigen emerges during the early stages of a CMV infection and is widely distributed in human vascular endothelial cells, peripheral blood leukocytes and human body fluids[16].…”