Ikeda Keigo, Nakajima Shihoko, Tanji Kana, Hirai Takuya, Uomori Kaori, Morimoto Shinji, Tomita Shigeki, Fukunaga Masaki, Tamura Naoto, Sekigawa Iwao
Department of Internal Medicine and Rheumatology, Juntendo University Urayasu Hospital, 2-1-1 Tomioka Urayasu-shi, Chiba, 279-0021, Japan.
Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan.
Rheumatol Int. 2017 Aug;37(8):1395-1399. doi: 10.1007/s00296-017-3693-6. Epub 2017 Mar 11.
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.
一名31岁患有系统性红斑狼疮和狼疮性肾炎的女性接受了泼尼松和免疫抑制剂治疗。在她的狼疮性肾炎症状恶化后，给予了大剂量类固醇和环磷酰胺脉冲治疗。患者出现肠穿孔，对乙状结肠进行了腹腔镜Hartmann手术。检测到血清巨细胞病毒（CMV）抗原C7HRP，患者被诊断为CMV结肠炎并接受了结肠切除术。尽管给予了更昔洛韦治疗，但严重便血仍持续，患者接受了腹腔镜全结肠切除术和部分回肠造口术。对于接受泼尼松和免疫抑制剂治疗以及有腹痛和便血的患者，应考虑CMV肠炎。因CMV肠炎导致肠穿孔的免疫功能低下患者预后较差。我们报告了一例病例并结合文献复习结果。
