title: Systemic lupus erythematosus complicated by cytomegalovirus-induced hemophagocytic syndrome and colitis.
abstract: Here, we report a case of systemic lupus erythematosus (SLE) complicated by cytomegalovirus (CMV)-induced hemophagocytic syndrome (HPS) and colitis. A 44-year-old woman with SLE was treated with corticosteroid and cyclophosphamide for lupus nephritis. Although her lupus nephritis improved, fever, progressive pancytopenia and intestinal bleeding were observed. A bone marrow aspiration showed an increase in mature histiocytes with hemophagocytosis. In addition, a colonoscopy showed hemorrhagic colitis with ulcer and the biopsy specimen from the colon revealed typical CMV cells with CMV inclusions confirmed by immunohistochemistry. Furthermore, a large number of CMV antigen-positive leukocytes was detected, suggesting an active CMV infection. CMV infection is serious in compromised hosts. Therefore clinicians should be aware of the clinical settings in which this infection can arise and the target organs potentially affected in order to initiate the appropriate intervention.
authors.affiliation: First Department of Internal Medicine, Kumamoto University School of Medicine.
authors.forename: Osamu
authors.initials: O
authors.lastname: Sakamoto
authors.forename: Makoto
authors.initials: M
authors.lastname: Ando
authors.forename: Shinichi
authors.initials: S
authors.lastname: Yoshimatsu
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Kohrogi
authors.forename: Moritaka
authors.initials: M
authors.lastname: Suga
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ando
mesh_terms: D000328:Adult; D000361:Agammaglobulinemia / Q000209:etiology; D001327:Autoimmune Diseases / Q000150:complications* / Q000188:drug therapy; D003092:Colitis / Q000150:complications* / Q000821:virology; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications*; D017809:Fatal Outcome; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D015616:Histiocytosis, Non-Langerhans-Cell / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007416:Intestinal Perforation / Q000209:etiology; D007962:Leukocytes / Q000821:virology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008181:Lupus Nephritis / Q000150:complications; D009102:Multiple Organ Failure / Q000209:etiology; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone