J Rheum Dis.  2011 Sep;18(3):224-228. 10.4078/jrd.2011.18.3.224.

A Case of Cytomegalovirus Infection Presenting as Pericarditis and Lupus Nephritis Flare-up

• Kim DH
• Na YS
• Lee HJ
• Kim YS
• Kim HS

• KMID: 2223156
• DOI: http://doi.org/10.4078/jrd.2011.18.3.224

Abstract

Cytomegalovirus (CMV) infection is associated with an exacerbations of systemic lupus erythematosus (SLE), but the role of CMV in disease pathogenesis remains unclear. CMV infection is often severe and difficult to diagnose in patients with SLE. Only a few cases of opportunistic CMV interstitial pneumonitis infection occurring in patients with SLE after intensive immunosuppressive therapy have been described. We report a case of CMV infection presenting with massive pericarditis and aggravating lupus nephritis in a patient who did not undergo any kind of immunosuppressive therapy except for low dose steroids to treat concomitant pulmonary tuberculosis. After diagnosis, the patient was successfully treated with immunoglobulin and ganciclovir. This case may support the theory that CMV infection is a potential trigger for SLE.

Keyword

Cytomegalovirus; Pericarditis; Systemic lupus erythematosus

MeSH Terms

Cytomegalovirus
Cytomegalovirus Infections
Ganciclovir
Humans
Immunoglobulins
Lung Diseases, Interstitial
Lupus Erythematosus, Systemic
Lupus Nephritis
Pericarditis
Steroids
Tuberculosis, Pulmonary
Ganciclovir
Immunoglobulins
Steroids

Figure

• 

  Figure 1. (A) Chest X-ray demonstrates a large cardiac silhouette, and thoracic effusion of costoph-renic angle blunting. (B) After ganciclovir treatment, cardiome-galy and pleural effusions disap-peared.

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  Figure 2. (A) Transthoracic echocardiogram reveals a large echolucent area (arrow) of pericardial effusion, especially in the right atrial aspect from the subcostal approach. (B) After ganciclovir treatment, the echolucent area of pericardial effusion was markedly decreased (arrow).

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  Figure 3. The patient's clinical course indicated that fever and inflammation improved after ganciclovir treatment. IVIG: Intravenous immune globulin, DEXA: Dexamethasone, ESR: Erythrocyte sedimentation rate.

Reference

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