CMV Reactivation after Low Dose Steroid Treatment

Abstract

Cytomegalovirus (CMV) is a virus transmitted from person to person, capable of remaining latent throughout a person's life. While primary infection often manifests with flu‐like symptoms in childhood, reactivation infections can occur in adulthood, especially in immunosuppressed conditions. CMV presents clinically as syndromes or end‐organ diseases such as pneumonia, hepatitis, retinitis, and colitis. The use of corticosteroids is identified as a risk factor for CMV reactivation. A 27‐year‐old female patient with no known chronic diseases, except asthma, initially sought care at another facility. there, a diagnosis could not be established and the administered antibiotic were ineffective. Subsequently, she was referred to our hospital. In our hospital initially other potential diagnoses causing fever were ruled out. CMV IgM and IgG were positive; Ig G was with low avidity. In the patient's previous tests, CMV IgG positivity from 3 years ago was identified. CMV PCR results indicated 46960 copies/mL. The patient's history of receiving intravenous and oral corticosteroids for asthma exacerbation led to the diagnosis of CMV reactivation. Following ganciclovir treatment, the patient's fever subsided, and upon negative CMV PCR results, she was discharged in good health. CMV reactivation can occur after low‐dose short‐term steroid treatments. CMV should be considered in the etiology of unexplained fever.

Keywords

• CMV
• reactivation
• steroid
• infectious diseases

Düşük Doz Steroid Tedavisi Sonrası Gelişen CMV Reaktivasyonu

Abstract

Cytomegalovirus (CMV) insandan insana bulaşan ve ömür boyu latent kalabilen bir virüstür. Primer enfeksiyonu daha sıklıkla gribal şikâyetlerle çocukluk döneminde karşımıza çıkmaktayken vücutta latent kalarak özellikle immunsupresan durumlarda reaktivasyon enfeksiyonları yetişkinlik çağında görülebilmektedir. CMV sendromu ya da pnömoni, hepatit, retinit, kolit gibi end‐organ CMV hastalığı olarak klinik vermektedir. Kortikosteroid kullanımı CMV reaktivasyonu için risk faktörüdür. Astım harici bilinen kronik hastalığı olmayan 27 yaşındaki kadın hasta ateş, halsizlik, nefes darlığı şikâyetleri ile dış merkezde tetkik edilmiş, verilen antibiyoterapilere rağmen klinik yanıt alınamaması ve tanı konulamaması üzerine hastanemize başvurdu. Nedeni bilinmeyen ateş ön tanısıyla yatırıldı ve ateş etyolojisinde rol oynayan tanılar dışlandı. CMV Ig M ve G pozitif, avidite düşük olarak sonuçlandı. Hastanın 3 yıl önce yapılan tahlillerinde CMV IgG pozitifliği olduğu görüldü. Alınan CMV PCR sonucu 46960 copy/mL olarak sonuçlandı. Hastanın anamnezinde astım atağı sebebiyle acil başvurularında intravenöz olarak ve ardından oral olarak kortikosteroid alma öyküsü olması sebebiyle CMV reaktivasyonu tanısı konuldu. Gansiklovir tedavisinin ardından ateşi düşen ve kliniği düzelen hasta CMV PCR sonucunun negatifleşmesi görüldükten sonra şifa ile taburcu edildi. CMV reaktivasyonu düşük doz kısa süreli steroid tedavileri sonrası da gelişebilmekte olup hastalara steroid verilirken dikkatli olunmalıdır. Nedeni bilinmeyen ateş etyolojisinde CMV’nin de olduğu akılda tutulmalıdır.

Keywords

• CMV
• reaktivasyon
• steroid
• enfeksiyon hastalıkları

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