Journal List > J Rheum Dis > v.18(3) > 1063918

Kim, Na, Lee, Kim, and Kim: A Case of Cytomegalovirus Infection Presenting as Pericarditis and Lupus Nephritis Flare-up

Abstract

Cytomegalovirus (CMV) infection is associated with an ex-acerbations of systemic lupus erythematosus (SLE), but the role of CMV in disease pathogenesis remains unclear. CMV infection is often severe and difficult to diagnose in patients with SLE. Only a few cases of opportunistic CMV interstitial pneumonitis infection occurring in patients with SLE after intensive immunosuppressive therapy have been described. We report a case of CMV infection presenting with massive pericarditis and aggravating lupus nephritis in a patient who did not undergo any kind of immunosuppressive therapy except for low dose steroids to treat concomitant pulmonary tuberculosis. After diagnosis, the patient was successfully treated with immunoglobulin and ganciclovir. This case may support the theory that CMV infection is a potential trigger for SLE.

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Figure 1.
(A) Chest X-ray demonstrates a large cardiac silhouette, and thoracic effusion of costoph-renic angle blunting. (B) After ganciclovir treatment, cardiome-galy and pleural effusions disap-peared.
jrd-18-224f1.tif
Figure 2.
(A) Transthoracic echocardiogram reveals a large echolucent area (arrow) of pericardial effusion, especially in the right atrial aspect from the subcostal approach. (B) After ganciclovir treatment, the echolucent area of pericardial effusion was markedly decreased (arrow).
jrd-18-224f2.tif
Figure 3.
The patient's clinical course indicated that fever and inflammation improved after ganciclovir treatment. IVIG: Intravenous immune globulin, DEXA: Dexamethasone, ESR: Erythrocyte sedimentation rate.
jrd-18-224f3.tif
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