title: Intestinal perforation due to hemorrhagic Cytomegalovirus enteritis in a patient with severe uncontrolled lupus nephritis: a case and review of the literature.
abstract: A 31-year-old woman with systemic lupus erythematosus and lupus nephritis was treated with prednisone and immunosuppressants. After her lupus nephritis symptoms worsened, both high-dose steroid and cyclophosphamide pulse therapy were administered. The patient developed an intestinal perforation, and laparoscopic Hartmann's surgery was performed on the sigmoid colon. Serum Cytomegalovirus (CMV) antigen C7HRP was detected, and the patient was diagnosed with CMV colitis and underwent a colon resection. Severe hematochezia continued despite ganciclovir administration, and the patient underwent laparoscopic total colectomy and partial ileostomy. CMV enteritis should be considered in patients treated with prednisone and immunosuppressants and those who have abdominal pain and hematochezia. Immunocompromised patients with intestinal perforation due to CMV enteritis have a poor prognosis. We report a case with along with the results of a literature review.
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan. keigo@juntendo.ac.jp.
authors.forename: Keigo
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Shihoko
authors.initials: S
authors.lastname: Nakajima
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kana
authors.initials: K
authors.lastname: Tanji
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Hirai
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Uomori
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Morimoto
authors.affiliation: Department of Pathology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Tomita
authors.affiliation: Department of Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Fukunaga
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tamura
authors.affiliation: Department of Internal Medicine and Rheumatology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan.
authors.forename: Iwao
authors.initials: I
authors.lastname: Sekigawa
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001623:Betamethasone / Q000008:administration & dosage / Q000009:adverse effects; D003092:Colitis / Q000150:complications*; D012809:Colon, Sigmoid / Q000601:surgery; D003587:Cytomegalovirus / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000188:drug therapy; D004751:Enteritis / Q000150:complications* / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D007416:Intestinal Perforation / Q000209:etiology* / Q000601:surgery; D008181:Lupus Nephritis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D001623:Betamethasone; D011239:Prednisolone; D015774:Ganciclovir; D016559:Tacrolimus
keywords: Colitis; Cytomegalovirus; Intestinal perforation; Systemic lupus erythematosus