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Wiener klinische Wochenschrift

, Volume 119, Issue 13–14, pp 435–437 | Cite as

Cytomegalovirus reactivation after low-dose steroid treatment for hemolytic anemia in a patient with primary Epstein-Barr virus infection

  • Biserka Troselj-Vukic
  • Irena MiloticEmail author
  • Franko Milotic
  • Marija Crnic-Martinovic
  • Blazenka Grahovac
Case Report

Summary

Cytomegalovirus reactivation is a well described event occurring after intensive therapeutic suppression of the immune function in patients with latent infection. Treatment protocols for suppression of the immune response often include high-dose steroids. However, it is not known whether even a low-dose steroid treatment can reactivate latent cytomegalovirus in otherwise healthy persons. We documented cytomegalovirus reactivation after low-dose steroid treatment for autoimmune hemolytic anemia as a complication of Epstein-Barr virus mononucleosis in an immunocompetent 21-year-old man.

Keywords

Cytomegalovirus reactivation Steroid therapy Epstein-Barr mononucleosis 

Reaktivierung von latentem Cytomegalovirus nach niedrigdosierter Kortikosteroidtherapie einer hämolytischen Anämie bei einem Patienten mit primärer Epstein-Barr-Virus-Infektion

Zusammenfassung

Bei Cytomegalie-seropositiven Patienten kann eine intensive therapeutische Suprimierung der Immunabwehr zur Reaktivierung einer latenten Cytomegalovirus-Infektion führen. Viele dieser immunsuppressiven Therapie-Protokolle enthalten auch hochdosierte Kortikosteroide. Nicht bekannt ist hingegen, ob eine Behandlung mit niedrigen Dosen von Kortikosteroiden bei sonst gesunden Personen eindeutig mit einer Reaktivierung von Cytomegalovirus verbunden ist. Wir beschreiben die Reaktivierung einer Cytomegalovirus-Infektion mit bei einem 21-jährigen immunkompetenten Mann, der einen Monat lang mit niedrigen Dosen von Kortikosteroiden behandelt wurde. Die Indikation zur Steroidtherapie war eine ausgeprägte hämolytische Anämie, ausgelöst durch eine primäre Mononukleose (Epstein-Barr).

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References

  1. Mocarski ES, Courcelle CT (2001) Cytomegaloviruses and their replication. In: Knipe DM, Howley PM (eds) Fields virology. Lippincott Wiliams & Wilkins, Philadelphia Tokyo, pp 2629–2673Google Scholar
  2. Meylan PR, Pascual M (2006) Preventing post-organ transplantation cytomegalovirus disease with ganciclovir: a meta-analysis comparing prophylactic and preemptive therapies. Clin Infect Dis 43 (7): 869–880CrossRefGoogle Scholar
  3. Macsween KF, Crawford DH (2003) Epstein-Barr virus – recent advances. Lancet Infect Dis 3: 131–140PubMedCrossRefGoogle Scholar
  4. Jenson HB (2000) Acute complications of Epstein-Barr virus infectious mononucleosis. Curr Opin Pediatr 12 (3): 263–268PubMedCrossRefGoogle Scholar
  5. Yoda Y, Hanaoka R, Ide H, Isozaki T, Matsunawa M, Yajima N, et al (2006) Clinical evaluation of patients with inflammatory connective tissue diseases complicated by cytomegalovirus antigenemia. Mod Rheumatol 16 (3): 137–142PubMedCrossRefGoogle Scholar
  6. Rossini F, Terruzzi E, Cammarota S, Morini F, Fumagalli M, Verga L, et al (2005) Cytomegalovirus infection after autologous stem cell transplantation: incidence and outcome in a group of patients undergoing a surveillance program. Transpl Infect Dis 7: 122–125PubMedCrossRefGoogle Scholar
  7. Cheung TW, Teich SA (1999) Cytomegalovirus infection in patients with HIV infection. Mt Sinai J Med 66: 113–124PubMedGoogle Scholar
  8. Jarvis MA, Nelson JA (2002) Mechanisms of human cytomegalovirus persistence and latency. Front Biosci 7: 1575–1582CrossRefGoogle Scholar
  9. Harma M, Hockerstedt K, Lyytikainen O, Lautenschlager I (2006) HHV-6 and HHV-7 antigenemia related to CMV infection after liver transplantation. J Med Virol 78 (6): 800–805PubMedCrossRefGoogle Scholar
  10. Aalto SM, Linnavuori K, Peltola H, Vuori E, Weissbrich B, Schubert J, et al (1998) Immunoreactivation of Epstein-Barr virus due to cytomegalovirus primary infection. J Med Virol 56 (3): 186–191PubMedCrossRefGoogle Scholar
  11. Arcenas R, Widen RH (2002) Epstein-Barr virus reactivation after superinfection of the BJAB-B1 and P3HR-1 cell lines with cytomegalovirus. BMC Microbiol 23 (2): 20CrossRefGoogle Scholar
  12. Barshes NR, Goodpastor SE, Goss JA (2004) Pharmacologic immunosuppression. Front Biosci 9: 411–420PubMedCrossRefGoogle Scholar
  13. Emery VC, Cope AV, Sabin CA, Burroughs AK, Rolles K, Lazzarotto T, et al (2000) Relationship between IgM antibody to human cytomegalovirus, virus load, donor and recipient serostatus, and administration of methylprednisolone as risk factors for cytomegalovirus disease after liver transplantation. J Infect Dis 182 (6): 1610–1615PubMedCrossRefGoogle Scholar
  14. Hassan-Walker AF, Kidd IM, Sabin C, Sweny P, Griffiths PD, Emery VC (1999) Quantity of human cytomegalovirus (CMV) DNAemia as a risk factor for CMV disease in renal allograft recipients: relationship with donor/recipient CMV serostatus, receipt of augmented methylprednisolone and antithymocyte globulin (ATG). J Med Virol 58 (2): 182–187PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Biserka Troselj-Vukic
    • 1
  • Irena Milotic
    • 2
    Email author
  • Franko Milotic
    • 1
  • Marija Crnic-Martinovic
    • 3
  • Blazenka Grahovac
    • 4
  1. 1.Clinic of Infectious DiseasesUniversity Hospital Center RijekaCroatia
  2. 2.Department of Infectious DiseasesGeneral Hospital CeljeSlovenia
  3. 3.Department of Transfusion MedicineUniversity Hospital Center RijekaCroatia
  4. 4.Department of Pathology, Medical FacultyUniversity of RijekaCroatia

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