title: Virus-Associated Hemophagocytic Syndrome related to acute CMV and HBV sexual co-infection: a case report.
abstract: BACKGROUND
  Secondary or reactive hemophagocytic syndrome is frequently related to viral infections and is named Virus-Associated Hemophagocytic Syndrome (VAHS). Cytomegalovirus (CMV) has been associated with hemophagocytic syndrome in healthy subjects, patients with inflammatory bowel diseases rheumatologic diseases, and transplant recipients. CMV and hepatitis B virus (HBV) can be sexually transmitted. However, co-infection with these viruses has never been reported and the clinical follow-up after acute HBV-CMV infection is not known.
  
  
  OBJECTIVE
  To report on the first case of a VAHS related to acute CMV and HBV co-infection probably acquired after sexual contact.
  
  
  METHODS
  A 47-year-old woman, with no past medical history, complaining of severe asthenia, pneumonia, myalgia, and high fever, was hospitalized for the first time on July 5, 2008. During 20 days, her CMV viral load and HBV DNA were monitored.
  
  
  RESULTS
  Ten days after her hospitalization, all signs and symptoms worsened. Twenty days after hospitalization, the patient had a natural recovery from acute HBV infection and a rapid clearance of CMV infection. Three weeks later, the patient was discharged without any complaints.
  
  
  CONCLUSIONS
  This report points out the etiological role of CMV and HBV co-infection in VAHS due to probable sexual transmission.
authors.affiliation: Internal Medecine and Infectious Diseases Department, Hôpital Ambroise Paré, Marseille, France. philippe.halfon@alphabio.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Halfon
authors.forename: Frederique
authors.initials: F
authors.lastname: Retornaz
authors.forename: Didier
authors.initials: D
authors.lastname: Mathieu
authors.forename: Thierry
authors.initials: T
authors.lastname: Helbert
authors.forename: Patrick
authors.initials: P
authors.lastname: Philibert
authors.forename: Hervé
authors.initials: H
authors.lastname: Pégliasco
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D005260:Female; D006509:Hepatitis B / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D006515:Hepatitis B virus; D006801:Humans; D051359:Lymphohistiocytosis, Hemophagocytic / Q000175:diagnosis / Q000188:drug therapy / Q000821:virology*; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D015229:Sexually Transmitted Diseases, Viral / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D019562:Viral Load
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone