Cytomegalovirus pneumonia in a patient with systemic lupus erythematosus

Abstract

We presented an interstitial pneumonia case developed due to very rarely seen cytomegalovirus (CMV) in a 66 year-old female patient who had systemic lupus erythematosus (SLE). This patient who was on prednisolone and cyclophosphamide developed high fever, dyspnea and rales in lungs, high CRP, leukopenia, and thrombocytopenia after 11 days of cyclophosphamide treatment. Interstitial infiltration was detected in thoracic tomography. CMV antigen and CMV-DNA by RT-PCR were positive in blood. It was considered as CMV pneumonia. Ganciclovir treatment was started. CMV antigen became negative in the 14th days of the treatment. Clinical improvement was observed at the same time. It is necessary to remember CMV as the agents responsible for causing pneumonia due to high mortality in immunosuppressive host such as SLE. In the blood CMV antigen and CMV DNA investigation may contribute to the diagnosis in that bronchoalveolar lavage cannot be performed.

Keywords

• -

Cytomegalovirus pneumonia in a patient with systemic lupus erythematosus

Öz

Anahtar Kelimeler

• -

Kaynakça

1. Leong KH, Boey ML, Feng PH. Coexiting Pnuemocystis car- inii pneumonia, cytomegalovirus pneumonitis and salmo- nellosis in systemic lupus erythematosus. Ann Rheum Dis 1992;50:811-812.
2. Trager J, Ward MM. Mortality and causes of death in systemic lupus erythematosus. Curr Opin Rheumatol 2001;13:345- 351.
3. Ng WL, Chu CM, Wu AK, Cheng VC, Yuen KY. Lymphopenia at presentation is associated with increased risk of infections in patients with systemic lupus erythematosus. QJM 2006; 99:37-47.
4. Crumpacker CS, Zhang JL. Cytomegalovirus. In: Mandell GL, Bennet JE, Dolin R, eds. Principles and Practice of Infectıous Disease, 6th ed. Philadelphia: Churchill Living- stone, 2010:1971-1988.
5. Ku ASW, Lee KW, Wan KL, Chan WKY. Coexisting pneumo- cystis carinii and cytomegalovirus pneumonia in systemic lupus erythematosus. HKJ Paediatr 1999; 4:101-103.
6. Çiftci E, Yalcinkaya F, Ince E, et al. Pulmonary involvement in childhood-onset systemic lupus erythematosus: a report of five cases. Rheumatology (Oxford) 2004; 43: 587-591.
7. Reusser P. Opportunistic viral infections. In: Cohen J, Powder- ly WG. eds. Infectious Disease, 2nd ed. Elsevier, 2004:1169- 1181.
8. Cariani E, Pollara CP, Valloncini B, Perandin F, Bonfanti C, Manca N. Relationship between pp65 antigenemia levels and real-time quantitative DNA PCR for Human Cytomegalo- virus (HCMV) management in immuncompromised patients. BMC Infect Dis 2007;7:138-142.

9. Gentile G, Picardi A, Capobianchi A, et al. A prospective study comparing quantitative Cytomegalovirus (CMV) polymerase chain reaction in plasma and pp65 antigenemia assay in monitoring patients after allogeneic stem cell transplantation. BMC Infect Dis 2006;6:167.
10. Tokunaga Y, Takenaka K, Asayama R, Shibuya T. Cytomeg- alovirus-induced interstitial pneumonitis in patient with sys- temic lupus erythematosus. Intern Med 1996;35:517-520.
11. Matsuki H, Kuwano K, Yoshimi M, et al. Spontaneous recov- ery from cytomegalovirus pneumonia. Nihon Kyobu Shikkan Gakkai 1997;35:67-71.
12. Tanaka Y, Seo R, Nagai Y, et al. Systemic lupus erythema- tosus complicated by cytomegalovirus-induced hemophago- cytic syndrome and pneumonia. Nihon Rinsho Meneki Gak- kai Kaishi 2008; 31:71-75.
13. Garcia-Porrua C, Gonzalez-Gay MA, Perez de Llano LA, Alvarez-Ferreira J. Fatal interstitial pneumonia due to cyto- megalovirus following cyclophosphamide treatment in a pa- tient with systemic lupus erythematosus. Scand J Rheumatol 1998;27:4656.
14. Cunha BA, Gouzhva O, Nausheen S. Severe cytomegalovi- rus (CMV) community-acquired pneumonia (CAP) precipitat- ing a systemic lupus erythematosus (SLE) flare. Heart Lung 2009; 38:249-252.