Systemic Lupus Erythematosus Complicated by Cytomegalovirus-Induced Hemophagocytic Syndrome and Colitis.

Abstract

Here, wereport a case of systemic lupus erythematosus (SLE) complicated by cytomegalovirus (CMV)-induced hemophagocytic syndrome (HPS) and colitis. A 44-year-old womanwith SLE was treated with corticosteroid and cyclophosphamide for lupus nephritis. Although her lupus nephritis improved, fever, progressive pancytopenia and intestinal bleeding were observed. A bone marrow aspiration showed an increase in mature histiocytes with hemophagocytosis. In addition, a colonoscopy showed hemorrhagic colitis with ulcer and the biopsy specimen from the colon revealed typical CMVcells with CMVinclusions confirmed by immunohistochemistry. Furthermore, a large number of CMVantigen-positive leukocytes was detected, suggesting an active CMVinfection. CMVinfection is serious in compromised hosts. Therefore clinicians should be aware of the clinical settings in which this infection can arise and the target organs potentially affected in order to initiate the appropriate intervention. (Internal Medicine 41: 151-155, 2002)

Incidental discovery of high systemic lupus erythematosus disease activity associated with cytomegalovirus viral activity

“…The last hypothesis seems to be the most promising, because CMV infection has an association with SLE [18], exacerbates SLE [19], and also has been found to be able to induce the expression of autoantigen, Ro/ SS-A on keratinocyte and calreticulin in Wbroblast [20,21]. Furthermore, it is considered that the immunosupression due to the use of steroid or cytotoxics in SLE patients might contribute toward the reactivation of CMV in some cases with particular susceptibility [22][23][24][25] and vice-versa [26], which might result in a vicious cycle to worsen SLE. To block the vicious cycle, identifying high risk patients, screening CMV seropositivity, and doing baseline CMV PCR/antigen assay were recommended by Yoon et al [25].…”

Cytomegalovirus Colitis Following Immunosuppressive Therapy for Lupus Peritonitis and Lupus Nephritis

“…CMVantigenemia assay is highly sensitive and becomes positive rapidly during the early stages of the disease; more than one positive Ieukocyte/1.5xl05 total leukocytes is clinically significant (1 1). Although CMVcolitis is a commonviral infection that typically occurs during the course of humanimmunodeficiency virus (HIV) infection, manifesting as intermittent diarrhea accompanied with fever and weight loss (12), CMV colitis complicated with SLE is relatively rare (13,14). Here, the differential diagnosis of lupus vasculitis and CMVcolitis becomes a problem in the present case.…”

Fatal cytomegalovirus infection with CD4+ T-lymphocytopenia durincg corticosteroid therapy for bronchial asthma

“…lymphocytopenia. Disseminated CMV infection is common in patients with AIDS or organ transplantation [1], and has been reported in patients with immunosuppressive agents [2][3][4]. However, disseminated CMV infection with use of corticosteroid without pulsed methylprednisolone or other immunosuppressive agents is rare [4][5][6][7].…”