Düşük Doz Steroid Tedavisi Sonrası Gelişen CMV Reaktivasyonu

Year 2024, Volume: 3 Issue: 2, 52 - 55, 25.08.2024

Fatma Kesmez Can , Kübra Gögebakan , Handan Alay , Ayse Albayrak , Kemalettin Özden

https://doi.org/10.61745/jsmsau.1400659

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

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

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