Fatal cytomegalovirus infection with CD4+ T-lymphocytopenia during corticosteroid therapy for bronchial asthma.
An 80-year-old woman was admitted with dyspnea. She had been treated with oral prednisolone for bronchial asthma. She was intravenously treated with dexamethasone. On the 9th day, she presented oliguria and thrombocytopenia. She was diagnosed as dehydration and disseminated intravascular coagulation, and was treated with hydration and heparin infusion. On the 12th day, she presented macroscopic hematuria and melena. Cystoscopy revealed hemorrhagic cystitis. Bone marrow aspiration showed hemophagocytosis. Serum antigen of cytomegalovirus (CMV) was positive. CD4+ T cell count was very low (40/microL). She was diagnosed as disseminated CMV infection, and was treated with gancyclovir and immunoglobulin infusion. On the 14th day, she died of pneumonia. This is the first report of fatal CMV infection during corticosteroid therapy for bronchial asthma.
Division of Internal Medicine, Saiseikai Kanazawa Hospital, Akatsuchimachi Ni 13-6, Kanazawa, 920-0353, Japan. kotarooe316@yahoo.co.jp
Kotaro
K
Oe
Tsutomu
T
Araki
Haruhiko
H
Ogawa
Akikatsu
A
Nakashima
Katsuaki
K
Sato
D000369:Aged, 80 and over; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D003586:Cytomegalovirus Infections / Q000276:immunology* / Q000473:pathology; D003907:Dexamethasone / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D011014:Pneumonia / Q000188:drug therapy / Q000276:immunology / Q000473:pathology; D011239:Prednisolone / Q000627:therapeutic use; D018344:T-Lymphocytopenia, Idiopathic CD4-Positive / Q000276:immunology / Q000821:virology*
D000893:Anti-Inflammatory Agents; D003907:Dexamethasone; D011239:Prednisolone