[Management of cytomegalovirus infections in patients treated with immunosuppressive drugs for chronic inflammatory diseases].
BACKGROUND
For patients with chronic inflammatory disease treated by immunosuppressive agents (for example: rheumatoid arthritis or systemic lupus erythematosus), there are no available guidelines in medical literature on the use of antiviral agents for the management of symptomatic cytomegalovirus (CMV) infection.


METHODS
A patient treated by methotrexate for a spondylarthritis presented a CMV infection manifested with persistent fever and pneumonia. CMV pp65 antigenemia was of 120 positive nuclei for 100,000 cells. Treatment with valganciclovir allowed a prompt recovery, while treatment by methotrexate was maintained.


CONCLUSIONS
Symptomatic CMV infection evolution is unpredictable and potentially severe in patients with chronic inflammatory diseases receiving immunosuppressive agents. Although there is no data issued from clinical trials, the observation reported in this article and the publications of similar cases in the medical literature indicate that treatment with valganciclovir seems worth to be used in this context. Stopping immunosuppressive therapy does not seem mandatory.
Tnani
N
N
Service de médecine interne, hôpital Ambroise-Paré, université Versailles-Saint-Quentin-en-Yvelines, 92104 Boulogne-Billancourt cedex, France.
Massoumi
A
A
Lortholary
O
O
Soussan
P
P
Prinseau
J
J
Baglin
A
A
Hanslik
T
T
D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000188:drug therapy*; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008727:Methotrexate / Q000009:adverse effects*; D008875:Middle Aged; D009894:Opportunistic Infections / Q000188:drug therapy*; D025241:Spondylarthritis / Q000188:drug therapy; D000077562:Valganciclovir
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000077562:Valganciclovir; D015774:Ganciclovir; D008727:Methotrexate