Skip to main content

Advertisement

SpringerLink
Log in

Intestinal perforation due to hemorrhagic Cytomegalovirus enteritis in a patient with severe uncontrolled lupus nephritis: a case and review of the literature

  • Cases with a Message
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

A 31-year-old woman with systemic lupus erythematosus and lupus nephritis was treated with prednisone and immunosuppressants. After her lupus nephritis symptoms worsened, both high-dose steroid and cyclophosphamide pulse therapy were administered. The patient developed an intestinal perforation, and laparoscopic Hartmann’s surgery was performed on the sigmoid colon. Serum Cytomegalovirus (CMV) antigen C7HRP was detected, and the patient was diagnosed with CMV colitis and underwent a colon resection. Severe hematochezia continued despite ganciclovir administration, and the patient underwent laparoscopic total colectomy and partial ileostomy. CMV enteritis should be considered in patients treated with prednisone and immunosuppressants and those who have abdominal pain and hematochezia. Immunocompromised patients with intestinal perforation due to CMV enteritis have a poor prognosis. We report a case with along with the results of a literature review.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Drew WL (1992) Cytomegalovirus infection in patients with AIDS. Clin Infect Dis 14(2):608–615

    Article  CAS  PubMed  Google Scholar 

  2. Bang S, Park YB, Kang BS, Park MC, Hwang MH, Kim HK, Lee SK (2004) CMV enteritis causing ileal perforation in underlying lupus enteritis. Clin Rheumatol 23(1):69–72. doi:10.1007/s10067-003-0825-z

    Article  PubMed  Google Scholar 

  3. Khan FN, Prasad V, Klein MD (2009) Cytomegalovirus enteritis mimicking Crohn’s disease in a lupus nephritis patient: a case report. World J Gastroenterol 15(34):4327–4330

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Sakamoto O, Ando M, Yoshimatsu S, Kohrogi H, Suga M, Ando M (2002) Systemic lupus erythematosus complicated by cytomegalovirus-induced hemophagocytic syndrome and colitis. Intern Med 41(2):151–155

    Article  PubMed  Google Scholar 

  5. Ramos-Casals M, Cuadrado MJ, Alba P, Sanna G, Brito-Zeron P, Bertolaccini L, Babini A, Moreno A, D’Cruz D, Khamashta MA (2008) Acute viral infections in patients with systemic lupus erythematosus: description of 23 cases and review of the literature. Medicine (Baltimore) 87(6):311–318. doi:10.1097/MD.0b013e31818ec711

    Article  Google Scholar 

  6. Weening JJ, D’Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. J Am Soc Nephrol 15(2):241–250

    Article  PubMed  Google Scholar 

  7. Miyasaka N, Kawai S, Hashimoto H (2009) Efficacy and safety of tacrolimus for lupus nephritis: a placebo-controlled double-blind multicenter study. Mod Rheumatol 19(6):606–615. doi:10.1007/s10165-009-0218-5

    Article  CAS  PubMed  Google Scholar 

  8. Mok CC, Tong KH, To CH, Siu YP, Au TC (2005) Tacrolimus for induction therapy of diffuse proliferative lupus nephritis: an open-labeled pilot study. Kidney Int 68(2):813–817. doi:10.1111/j.1523-1755.2005.00461.x

    Article  CAS  PubMed  Google Scholar 

  9. Ho M (2008) The history of cytomegalovirus and its diseases. Med Microbiol Immunol 197(2):65–73. doi:10.1007/s00430-007-0066-x

    Article  PubMed  Google Scholar 

  10. Cohen JI, Corey GR (1985) Cytomegalovirus infection in the normal host. Medicine (Baltimore) 64(2):100–114

    Article  CAS  Google Scholar 

  11. Meyers JD, Flournoy N, Thomas ED (1986) Risk factors for cytomegalovirus infection after human marrow transplantation. J Infect Dis 153(3):478–488

    Article  CAS  PubMed  Google Scholar 

  12. Mayoral JL, Loeffler CM, Fasola CG, Kramer MA, Orrom WJ, Matas AJ, Najarian JS, Dunn DL (1991) Diagnosis and treatment of cytomegalovirus disease in transplant patients based on gastrointestinal tract manifestations. Arch Surg 126(2):202–206

    Article  CAS  PubMed  Google Scholar 

  13. Hayashi T, Lee S, Ogasawara H, Sekigawa I, Iida N, Tomino Y, Hashimoto H, Hirose S (1998) Exacerbation of systemic lupus erythematosus related to cytomegalovirus infection. Lupus 7(8):561–564

    Article  CAS  PubMed  Google Scholar 

  14. Sekigawa I, Nawata M, Seta N, Yamada M, Iida N, Hashimoto H (2002) Cytomegalovirus infection in patients with systemic lupus erythematosus. Clin Exp Rheumatol 20(4):559–564

    CAS  PubMed  Google Scholar 

  15. Ikeda K, Takasaki Y, Sekigawa I (2016) Rapid onset of small intestinal perforation after successful steroid treatment in eosinophilic granulomatosis with polyangiitis. Mod Rheumatol 26(6):968–970. doi:10.3109/14397595.2014.940126

    Article  Google Scholar 

  16. Mori T, Kameda H, Ogawa H, Iizuka A, Sekiguchi N, Takei H, Nagasawa H, Tokuhira M, Tanaka T, Saito Y, Amano K, Abe T, Takeuchi T (2004) Incidence of cytomegalovirus reactivation in patients with inflammatory connective tissue diseases who are under immunosuppressive therapy. J Rheumatol 31(7):1349–1351

    PubMed  Google Scholar 

  17. Strasser C, Wolf EM, Kornprat P, Hermann J, Munch A, Langner C (2012) Opportunistic cytomegalovirus infection causing colonic perforation in a patient with systemic lupus erythematosus. Lupus 21(4):449–451. doi:10.1177/0961203311425529

    Article  CAS  PubMed  Google Scholar 

  18. Boeckh M, Boivin G (1998) Quantitation of cytomegalovirus: methodologic aspects and clinical applications. Clin Microbiol Rev 11(3):533–554

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Boeckh M, Gooley TA, Bowden RA (1998) Effect of high-dose acyclovir on survival in allogeneic marrow transplant recipients who received ganciclovir at engraftment or for cytomegalovirus pp65 antigenemia. J Infect Dis 178(4):1153–1157

    Article  CAS  PubMed  Google Scholar 

  20. Kamei H, Ito Y, Onishi Y, Suzuki M, Imai H, Kurata N, Hori T, Tainaka T, Uchida H, Ogura Y (2016) Cytomegalovirus (CMV) monitoring after liver transplantation: comparison of CMV pp65 antigenemia assay with real-time PCR calibrated to WHO international standard. Ann Transplant 21:131–136

    Article  PubMed  Google Scholar 

  21. Kwon S, Jung BK, Ko SY, Lee CK, Cho Y (2015) Comparison of quantitation of cytomegalovirus DNA by real-time PCR in whole blood with the cytomegalovirus antigenemia assay. Ann Lab Med 35(1):99–104. doi:10.3343/alm.2015.35.1.99

    Article  PubMed  Google Scholar 

  22. Kim JW, Boo SJ, Ye BD, Kim CL, Yang SK, Kim J, Kim SA, Park SH, Park SK, Yang DH, Jung KW, Kim KJ, Byeon JS, Myung SJ, Kim JH (2014) Clinical utility of cytomegalovirus antigenemia assay and blood cytomegalovirus DNA PCR for cytomegaloviral colitis patients with moderate to severe ulcerative colitis. J Crohns Colitis 8(7):693–701. doi:10.1016/j.crohns.2013.12.014

    Article  PubMed  Google Scholar 

  23. Ohashi N, Isozaki T, Shirakawa K, Ikegaya N, Yamamoto T, Hishida A (2003) Cytomegalovirus colitis following immunosuppressive therapy for lupus peritonitis and lupus nephritis. Intern Med 42(4):362–366

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by a JSPS (Japan Society for the Promotion of Science) KAKENHI Grant Number JP15K08107 (to KI).

Author information

Authors and Affiliations

  1. Department of Internal Medicine and Rheumatology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan

    Keigo Ikeda, Takuya Hirai, Shinji Morimoto & Iwao Sekigawa

  2. Department of Pathology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan

    Shigeki Tomita

  3. Department of Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan

    Masaki Fukunaga

  4. Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan

    Shihoko Nakajima, Kana Tanji, Kaori Uomori & Naoto Tamura

Authors
  1. Keigo Ikeda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shihoko Nakajima
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kana Tanji
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takuya Hirai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kaori Uomori
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Shinji Morimoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Shigeki Tomita
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Masaki Fukunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Naoto Tamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Iwao Sekigawa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keigo Ikeda.

Ethics declarations

Conflict of interest

The authors declare no conflicts of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ikeda, K., Nakajima, S., Tanji, K. et al. Intestinal perforation due to hemorrhagic Cytomegalovirus enteritis in a patient with severe uncontrolled lupus nephritis: a case and review of the literature. Rheumatol Int 37, 1395–1399 (2017). https://doi.org/10.1007/s00296-017-3693-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-017-3693-6

Keywords

Search

Navigation