title: Generalized Wegener's granulomatosis in an immunocompetent adult after cytomegalovirus mononucleosis and bacterial urinary tract infection.
abstract: Human cytomegalovirus (HCMV) is frequently detected in autoimmune diseases, but its role in such disorders is poorly understood. Herein we describe the case of a young woman who developed generalized Wegener's granulomatosis (WG) after HCMV mononucleosis and urinary tract infection. During mononucleosis, the patient had extraordinarily high plasma levels of proinflammatory cytokines such as interleukin-5 and lymphotoxin alpha, autoantibodies, and a higher blood level of viral DNA than were found in other immunocompetent patients infected with HCMV or healthy controls. Active HCMV replication was detected after the onset of vasculitis, and HCMV genomes or antigens were found in blood, urine, and inflammatory lesions on the kidney. Thus, HCMV may have triggered or exacerbated inflammation and autoimmunity in this case of WG.
authors.affiliation: Department of Medicine, Center for Molecular Medicine, Karolinska Institute, Stockholm, Sweden. stefania.varani@ki.se
authors.forename: Stefania
authors.initials: S
authors.lastname: Varani
authors.forename: Antonio
authors.initials: A
authors.lastname: Mastroianni
authors.forename: Giada
authors.initials: G
authors.lastname: Frascaroli
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tammik
authors.forename: Afsar
authors.initials: A
authors.lastname: Rahbar
authors.forename: Marta
authors.initials: M
authors.lastname: Christensson
authors.forename: Giada
authors.initials: G
authors.lastname: Rossini
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Landini
authors.forename: Cecilia
authors.initials: C
authors.lastname: Söderberg-Nauclér
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000032:analysis; D001323:Autoantibodies / Q000097:blood; D016207:Cytokines / Q000097:blood; D003586:Cytomegalovirus Infections / Q000150:complications*; D004279:DNA, Viral / Q000097:blood; D005260:Female; D014890:Granulomatosis with Polyangiitis / Q000209:etiology*; D006801:Humans; D007244:Infectious Mononucleosis / Q000150:complications*; D014552:Urinary Tract Infections / Q000150:complications*
chemical_list: D000956:Antigens, Viral; D001323:Autoantibodies; D016207:Cytokines; D004279:DNA, Viral