Düşük Doz Steroid Tedavisi Sonrası Gelişen CMV Reaktivasyonu

Yıl 2024, Cilt: 3 Sayı: 2, 52 - 55, 25.08.2024

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

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

Öz

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.

Anahtar Kelimeler

CMV, reaktivasyon, steroid, enfeksiyon hastalıkları

CMV Reactivation after Low Dose Steroid Treatment

Öz

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.

Anahtar Kelimeler

CMV, reactivation, steroid, infectious diseases

Kaynakça

• Schottstedt V, Blümel J, Burger R, et al. Human Cytomegalovirus (HCMV) – Revised. Transfusion Medicine and Hemotherapy. 2010;37(6):365-375. doi:10.1159/000322141
• Taylor GH. Cytomegalovirus. American family physician. 2003;67(3):519-524.
• Sinclair J, Sissons P. Latency and reactivation of human cytomegalovirus. Journal of General Virology. 2006;87(7):1763-1779. doi:10.1099/vir.0.81891-0
• Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Reviews in Medical Virology. 2010;20(4):202-213. doi:10.1002/rmv.655
• Osawa R, Singh N. Cytomegalovirus infection in critically ill patients: a systematic review. Critical Care. 2009;13(3):R68. doi:10.1186/cc7875
• Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients—Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clinical Transplantation. 2019;33(9). doi:10.1111/ctr.13512
• Lischka P, Zimmermann H. Antiviral strategies to combat cytomegalovirus infections in transplant recipients. Current Opinion in Pharmacology. 2008;8(5):541-548. doi:10.1016/j.coph.2008.07.002
• Lachance P, Chen J, Featherstone R, Sligl WI. Association Between Cytomegalovirus Reactivation and Clinical Outcomes in Immunocompetent Critically Ill Patients: A Systematic Review and Meta-Analysis. Open Forum Infectious Diseases. 2017;4(2). doi:10.1093/ofid/ofx029
• Lathey JL, Spector SA. Unrestricted replication of human cytomegalovirus in hydrocortisone-treated macrophages. Journal of Virology. 1991;65(11):6371-6375. doi:10.1128/jvi.65.11.6371-6375.1991
• Van Damme E, Sauviller S, Lau B, et al. Glucocorticosteroids trigger reactivation of human cytomegalovirus from latently infected myeloid cells and increase the risk for HCMV infection in D+R+ liver transplant patients. Journal of General Virology. 2015;96(1):131-143. doi:10.1099/vir.0.069872-0
• Hissong E, Chen Z, Yantiss RK. Cytomegalovirus reactivation in inflammatory bowel disease: an uncommon occurrence related to corticosteroid dependence. Modern Pathology. 2019;32(8):1210-1216. doi:10.1038/s41379-019-0258-0
• Sekiguchi A, Inoue Y, Yamazaki S, et al. Demographic and clinical characteristics of cytomegalovirus reactivation in dermatomyositis. The Journal of Dermatology. 2020;47(8):876-881. doi:10.1111/1346-8138.15409
• Kwak SH, Lee SH, Park MS, et al. Risk Factors for Cytomegalovirus Reactivation in Lung Transplant Recipients. Lung. 2020;198(5):829-838. doi:10.1007/s00408-020-00380-z
• Haddad LE, Ariza-Heredia E, Shah DP, et al. The Ability of a Cytomegalovirus ELISPOT Assay to Predict Outcome of Low-Level CMV Reactivation in Hematopoietic Cell Transplant Recipients. The Journal of Infectious Diseases. 2018;219(6):898-907. doi:10.1093/infdis/jiy592
• Troselj-Vukic B, Milotic I, Milotic F, Crnic-Martinovic M, Grahovac B. Cytomegalovirus reactivation after low-dose steroid treatment for hemolytic anemia in a patient with primary Epstein-Barr virus infection. Wiener Klinische Wochenschrift. 2007;119(13-14):435-437. doi:10.1007/s00508-007-0821-4