Abstract
We evaluated the occurrence of cytomegalovirus (CMV) infection and the background characteristics in twenty-three hospitalized patients with inflammatory connective tissue diseases including systemic lupus erythematosus, polymyositis/dermatomyositis, rheumatoid vasculitis, microscopic polyangitis, and Takayasu’s arteritis. Cytomegalovirus antigenemia was demonstrated in 10 of 23 evaluable patients. Five of ten patients with CMV antigenemia developed symptomatic CMV disease (all cases of fever, two cases of liver involvement, two cases of interstitial pneumonia, and one case of unknown organ involvement), whereas the remaining five patients were asymptomatic. Most of CMV antigenemia-positive patients had been administered intravenous steroid pulse, or in combination with immunosuppressive agents intravenously or orally because of refractory disease activity. Particularly, in patients who received intravenous methylprednisolone pulse in combination with additional intravenous cyclophosphamide pulse, the incidence of CMV antigenemia was markedly higher (four out of four). Four of ten CMV antigenemia-positive patients simultaneously showed detection of Pneumocystis jiroveci in induced sputum by PCR, increase in level of serum β-d-glucan and the finding of geographical ground-glass opacities on chest computed tomography. These findings suggested that patients with connective tissue diseases under intensive immunosuppressive therapies (intravenous steroid pulse in combination with additional intravenous cyclophosphamide pulse in particular) are highly susceptible to CMV infection and disease, and that patients complicated by CMV antigenemia are susceptible to combined opportunistic infection such as Pneumocystis pneumonia.
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References
M Juarez R Misischia GS Alarcon (2003) ArticleTitleInfections in systemic connective tissue diseases: systemic lupus erythematosus, scleroderma and polymyositis/dermatomyositis Rheum Dis Clin North Am 29 163–84 10.1016/S0889-857X(02)00100-X Occurrence Handle10.1016/S0889-857X(02)00100-X Occurrence Handle12635506
I Kang SH Park (2003) ArticleTitleInfectious complications in SLE after immunosuppressive therapies Curr Opini Rheumatol 15 528–34 10.1097/00002281-200309000-00002 Occurrence Handle10.1097/00002281-200309000-00002 Occurrence Handle1:CAS:528:DC%2BD3sXntVOqsr8%3D
G Zandman-Goddard Y Shoenfeld (2003) ArticleTitleSLE and Infections Clin Rev Allergy Immunol 25 29–40 10.1385/CRIAI:25:1:29 Occurrence Handle10.1385/CRIAI:25:1:29 Occurrence Handle12794259
MM Ward E Pyun S Studenski (1995) ArticleTitleCauses of death in systemic lupus erythematosus Arthritis Rheum 38 1492–9 Occurrence Handle10.1002/art.1780381016 Occurrence Handle1:STN:280:DyaK28%2FhslCntQ%3D%3D Occurrence Handle7575699
F Aglas F Riner J Hermann J Gretler E Huttl W Domej et al. (1995) ArticleTitleInterstitial pneumonia due to cytomegalovirus following low-dose methotrexate treatment for rheumatoid arthritis Arthritis Rheum 38 291–2 Occurrence Handle10.1002/art.1780380222 Occurrence Handle1:STN:280:DyaK2M7ltFSlsw%3D%3D Occurrence Handle7848322
Y Tokunaga K Takenaka R Asayama T Shibuya (1996) ArticleTitleCytomegalovirus-induced interstitial pneumonitis in a patient with systemic lupus erythematosus Intern Med 35 517–20 Occurrence Handle10.2169/internalmedicine.35.517 Occurrence Handle1:STN:280:DyaK28vjt1GmtQ%3D%3D Occurrence Handle8835609
C Garcia-Porrua MA Gonzalez-Gay LA Perez de Llano J Alvarez-Ferreira (1998) ArticleTitleFatal interstitial pneumonia due to cytomegalovirus following cyclophosphamide treatment in a patient with systemic lupus erythematosus Scand J Rheumatol 27 456–60
S Yoshihara N Fukuma R Masago (1999) ArticleTitleCytomegalovirus infection associated with immunosuppressive therapy in collagen vascular diseases Ryumachi 39 740–8 Occurrence Handle1:STN:280:DC%2BD3c%2FotFagtw%3D%3D Occurrence Handle10614168
Y Ikura T Matsuo M Ogami S Yamazaki M Okamura J Yoshikawa et al. (2000) ArticleTitleCytomegalovirus-associated pancreatitis in a patient with systemic lupus erythematosus J Rheumatol 27 2715–7 Occurrence Handle1:STN:280:DC%2BD3M7otVOqsQ%3D%3D Occurrence Handle11093460
T Tsuji M Misumi I Inoue H Ideguchi T Okubo A Ueda et al. (2001) ArticleTitleCytomegalovirus antigenemia assay as a useful tool for early diagnosis and therapy for cytomegalovirus infection in three cases with collagen diseases Jpn J Clin Immunol 24 29–35 Occurrence Handle1:STN:280:DC%2BD3MzisVeksw%3D%3D
T Mori H Kameda H Ogawa A Iizuka N Sekiguchi H Takei et al. (2004) ArticleTitleIncidence of cytomegalovirus reactivation in patients with inflammatory connective tissue diseases who are under immunosuppressive therapy J Rheumatol 31 1349–51 Occurrence Handle15229955
A Humar D Siegal G Moussa D Kumar (2005) ArticleTitleA prospective assessment of valganciclovir for the treatment of cytomegalovirus infection and disease in transplant recipients J Infect Dis 192 1154–7 10.1086/444398 Occurrence Handle10.1086/444398 Occurrence Handle1:CAS:528:DC%2BD2MXhtFCrs77F Occurrence Handle16136456
JK Preiksaitis DC Brennan J Fishman U Allen (2005) ArticleTitleCanadian society of Transplantation consensus workshop on cytomegalovirus management in solid organ transplantation final report Am J Transplant 5 218–27 10.1111/j.1600-6143.2004.00692.x Occurrence Handle10.1111/j.1600-6143.2004.00692.x Occurrence Handle15643981
TH The W van der Bij AP van den Berg M van der Giessen J Weits HG Sprenger et al. (1990) ArticleTitleCytomegalovirus antigenemia Clin Infect Dis 12 IssueIDSuppl 7 37–44
P Lesprit C Scieux M Lemann E Carbonelle J Modai JM Molina (1998) ArticleTitleUse of the cytomegalovirus antigenemia assay for the rapid diagnosis of primary CMV infection in hospitalized adults Clin Infect Dis 26 646–50 Occurrence Handle10.1086/514572 Occurrence Handle1:STN:280:DyaK1c7osFGhtA%3D%3D Occurrence Handle9524838
RH Rubin (1990) ArticleTitleImpact of cytomegalovirus infection on organ transplant recipients Clin Infect Dis 12 IssueIDSuppl 7 54–66
M Ho (1991) ArticleTitleObservations from transplantation contributing to the understanding of pathogenesis of CMV infection Transplant Proc 23 IssueIDSuppl 3 104–9 Occurrence Handle1:STN:280:DyaK3M3pslOksg%3D%3D Occurrence Handle1648810
K Saito S Nakayamada K Nakano M Tokunaga S Tsujimura K Nakatsuka et al. (2004) ArticleTitleDetection of Pneumocystis carinii by DNA amplification in patients with connective tissue disease: reevaluation of clinical features of P. carinii pneumonia in rheumatic diseases Rheumatol 43 479–85 10.1093/rheumatology/keh071 Occurrence Handle10.1093/rheumatology/keh071 Occurrence Handle1:CAS:528:DC%2BD2cXitlyhsb4%3D
T Sato S Inokuma R Maezawa H Nakayama K Hamasaki Y Miwa et al. (2005) ArticleTitleClinical characteristics of Pneumocystis carinii pneumonia in patients with connective tissue diseases Mod Rheumatol 15 191–7 10.1007/s10165-005-0395-9 Occurrence Handle10.1007/s10165-005-0395-9 Occurrence Handle17029061
WJ Britt (1998) Cytomegalovirus L Collier (Eds) Microbiology and microbial infections EditionNumber9th ed. Arnold London 339–43
V Vasquez RA Barzaga BA Cunha (1992) ArticleTitleCytomegalovirus-induced flare of systemic lupus erythematosus Heart Lung 21 IssueID4 407–8 Occurrence Handle1:STN:280:DyaK38zjt1ahtA%3D%3D Occurrence Handle1321097
T Hayashi S Lee H Ogasawara I Sekigawa N Iida Y Tomino et al. (1998) ArticleTitleExacerbation of systemic lupus erythematosus related to cytomegalovirus infection Lupus 7 IssueID8 561–4 10.1191/096120398678920596 Occurrence Handle10.1191/096120398678920596 Occurrence Handle1:STN:280:DyaK1M%2FnvFKjtw%3D%3D Occurrence Handle9863901
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Yoda, Y., Hanaoka, R., Ide, H. et al. Clinical evaluation of patients with inflammatory connective tissue diseases complicated by cytomegalovirus antigenemia. Mod Rheumatol 16, 137–142 (2006). https://doi.org/10.1007/s10165-006-0470-x
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DOI: https://doi.org/10.1007/s10165-006-0470-x