Rozenblyum E V, Levy D M, Allen U, Harvey E, Hebert D, Silverman E D
Divisions of Rheumatology
Divisions of Rheumatology Department of Pediatrics, and the Research Institute, Hospital for Sick Children, University of Toronto, Canada.
Lupus. 2015 Jun;24(7):730-5. doi: 10.1177/0961203314565443. Epub 2015 Jan 6.
Cytomegalovirus (CMV) is a beta-herpesvirus and antibodies to this virus are common in patients with systemic lupus erythematosus (SLE). However, few studies have examined the relationship between CMV infection and SLE.
Our objectives were: 1) to determine the prevalence of CMV infection at the time of SLE diagnosis, and 2) to determine the risk factors for CMV infection.
A database review of 670 patients with pediatric SLE (pSLE) seen over a 20-year period identified seven patients with a CMV infection detected at the time of diagnosis of SLE. CMV was diagnosed by serology, urine and bronchoalveolar lavage. Clinical manifestations, laboratory findings, virology studies and treatments were reviewed.
CMV infection was detected in seven patients at the time of SLE diagnosis (1.04% of total cohort): six were female: mean age was 13 years. Predominant features included non-Caucasian ethnicity (p < 0.01 as compared to total SLE cohort), persistent fevers on prednisone in seven and nephrotic syndrome in four. Laboratory findings included: anemia in seven, lymphopenia in five, elevated liver enzymes in four, with anti-dsDNA and anti-RNP antibodies present in six and five, respectively. Six patients received ganciclovir and CMV hyperimmune globulin (Cytogam®) with the continuation of prednisone during CMV treatment. Six of seven fully recovered without sequelae (one without treatment) but one patient died with active CMV infection.
There were 1.04% of patients with pSLE who developed CMV infection. All were of non-Caucasian ethnicity. Persistent fever despite prednisone, with concomitant anemia, may be additional clues to CMV infection in pSLE. We suggest all patients have routine testing for CMV immunity at initial presentation of pSLE.
巨细胞病毒（CMV）是一种β疱疹病毒，系统性红斑狼疮（SLE）患者中该病毒抗体很常见。然而，很少有研究探讨CMV感染与SLE之间的关系。
我们的目的是：1）确定SLE诊断时CMV感染的患病率，以及2）确定CMV感染的危险因素。
对20年间诊治的670例儿童SLE（pSLE）患者的数据库进行回顾，确定了7例在SLE诊断时检测到CMV感染的患者。通过血清学、尿液和支气管肺泡灌洗诊断CMV。回顾了临床表现、实验室检查结果、病毒学研究和治疗情况。
7例患者在SLE诊断时检测到CMV感染（占总队列的1.04%）：6例为女性，平均年龄13岁。主要特征包括非白种人种族（与整个SLE队列相比，p<0.01），7例患者使用泼尼松时持续发热，4例患者患有肾病综合征。实验室检查结果包括：7例贫血，5例淋巴细胞减少，4例肝酶升高，6例和5例分别存在抗双链DNA和抗RNP抗体。6例患者接受了更昔洛韦和CMV超免疫球蛋白（Cytogam®）治疗，CMV治疗期间继续使用泼尼松。7例患者中有6例完全康复且无后遗症（1例未接受治疗），但1例患者死于活动性CMV感染。
pSLE患者中有1.04%发生CMV感染。所有患者均为非白种人种族。尽管使用泼尼松仍持续发热，并伴有贫血，可能是pSLE中CMV感染的额外线索。我们建议所有pSLE初诊患者常规检测CMV免疫情况。
