Three patients with systemic lupus erythematosus complicated by cytomegalovirus colitis.

Matsubara, Akio; Hirata, Kazunobu; Nara, Hiroyuki; Kaneko, Naoko; Kano, Shogo; Minota, Seiji; Suzuki, Tomohiko

doi:10.2177/jsci.23.156

Cited by 4 publications

(2 citation statements)

References 6 publications

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“…In the area of dermatology, there are reports of CMV enteritis associated with SLE under steroid medication (15, 16). Although ulcerative colitis and Crohn's disease are well known as complications of PG, CMV enterocolitis should be considered in the differential diagnosis of enterocolitis in immunocompromised patients who received cyclosporin A or systemic corticosteroids.…”

Section: Discussionmentioning

confidence: 99%

A Case of Cytomegalovirus Colitis Following Immunosuppressive Treatment for Pyoderma Gangrenosum

Kikuchi

Nagamine

Setoyama

2005

The Journal of Dermatology

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We report a case of pyoderma gangrenosum (PG) complicated by cytomegalovirus (CMV)-induced colitis. A 79-year-old woman with PG was treated with corticosteroid and cyclosporin. She had blood in her stool and advancing anemia during the treatment. A colonoscopic biopsy specimen from the colon revealed typical CMV-infected cells with CMV inclusions confirmed by immunohistochemistry. Furthermore, there were many CMV-antigen-positive leukocytes, suggesting an active CMV infection, which is serious in compromised hosts. Although ulcerative colitis and Crohn's disease are well known as complications of PG, CMV enterocolitis should be considered in the differential diagnosis of enterocolitis in immunocompromised patients.

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Section: Discussionmentioning

confidence: 99%

A Case of Cytomegalovirus Colitis Following Immunosuppressive Treatment for Pyoderma Gangrenosum

Kikuchi

Nagamine

Setoyama

2005

The Journal of Dermatology

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“…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.…”

Section: Discussionmentioning

confidence: 84%

Cytomegalovirus Colitis Following Immunosuppressive Therapy for Lupus Peritonitis and Lupus Nephritis

et al. 2003

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Wereport a womanwith lupus nephritis complicated with lupus peritonitis and cytomegalovirus (CMV)colitis. Diagnosis of lupus peritonitiswas made by abdominal computed tomography scan, colonoscopy, and ascitic fluid analysis. Steroid and cyclophosphamide therapy resulted in the improvement of severe lupus nephritis and peritonitis. Thereafter, she developed multiple colonic ulcers as diagnosed by colonoscopy and positive CMV antigenemia assay. Treatment with ganciclovir resulted in the disappearance of colonic lesions. The low cluster of differentiation (CD)4+ lymphocyte count (41/mm3) suggested that the cell-mediated immunity of this patient was comparable to that seen in patients with acquired immunodeficiency syndrome (AIDS).

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Acute Viral Infections in Patients With Systemic Lupus Erythematosus

Ramos-Casals¹,

Cuadrado²,

Alba³

et al. 2008

Medicine

140

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Few studies have evaluated the impact of viral infections on the daily management of patients with systemic lupus erythematosus (SLE). We analyzed the etiology and clinical features of acute viral infections arising in patients with SLE and their influence on the diagnosis, prognosis, and treatment of SLE. Cases occurring within the last 5 years were selected from the databases of 3 large teaching hospitals. Acute viral infections were confirmed by the identification of specific antiviral IgM antibodies and subsequent seroconversion with detection of specific IgG antibodies. In autopsy studies, macroscopic findings suggestive of viral infection were confirmed by direct identification of the virus or viruses in tissue samples. We performed a MEDLINE search for additional cases reported between January 1985 and March 2008. We included 88 cases (23 from our clinics and 65 from the literature review) of acute viral infections in patients with SLE. Twenty-five patients were diagnosed with new-onset SLE (fulfillment of the 1997 SLE criteria) associated with infection by human parvovirus B19 (n = 15), cytomegalovirus (CMV; n = 6), Epstein-Barr virus (EBV; n = 3), and hepatitis A virus (n = 1). The remaining 63 cases of acute viral infections arose in patients already diagnosed with SLE: in 18 patients, symptoms related to infection mimicked a lupus flare, 36 patients, including 1 patient from the former group who presented with both conditions, presented organ-specific viral infections (mainly pneumonitis, colitis, retinitis, and hepatitis), and 10 patients presented a severe, multiorgan process similar to that described in catastrophic antiphospholipid syndrome-the final diagnosis was hemophagocytic syndrome in 5 cases and disseminated viral infection in 5. Twelve patients died due to infection caused by CMV (n = 5), herpes simplex virus (n = 4), EBV (n = 2), and varicella zoster virus (n = 1). Autopsies were performed in 9 patients and disclosed disseminated herpetic infection in 6 patients (caused by herpes simplex in 4 cases, varicella in 1, and CMV in 1) and hemophagocytic syndrome in 3. A higher frequency of renal failure (54% vs. 19%, p = 0.024), antiphospholipid syndrome (33% vs. 6%, p = 0.023), treatment with cyclophosphamide (82% vs. 37%, p = 0.008), and multisystemic involvement at presentation (58% vs. 8%, p < 0.001); and a lower frequency of antiviral therapy (18% vs. 76%, p < 0.001) were found in patients who died, compared with survivors. The most common viral infections in patients with SLE are parvovirus B19 (predominantly mimicking SLE presentation) and CMV (predominantly presenting in severely immunosuppressed patients). CMV infection may mimic a lupus flare or present with specific organ involvement such as gastrointestinal bleeding or pulmonary infiltrates. Other herpesviruses are common in immunosuppressed SLE patients and may produce a wide range of manifestations. Physicians should examine the pharynx, eyes, skin, and genitalia and should conduct serologic and molecular studies to improve early d...

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Three patients with systemic lupus erythematosus complicated by cytomegalovirus colitis.

Cited by 4 publications

References 6 publications

A Case of Cytomegalovirus Colitis Following Immunosuppressive Treatment for Pyoderma Gangrenosum

A Case of Cytomegalovirus Colitis Following Immunosuppressive Treatment for Pyoderma Gangrenosum

Cytomegalovirus Colitis Following Immunosuppressive Therapy for Lupus Peritonitis and Lupus Nephritis

Acute Viral Infections in Patients With Systemic Lupus Erythematosus

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