Department of Rheumatology, Imam Hossein Teaching Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Department of Pathology, Loghman Teaching Center, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Lupus. 2021 Jan;30(1):149-154. doi: 10.1177/0961203320961473. Epub 2020 Oct 5.
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease which can be complicated with cytomegalovirus (CMV) infection during its course. CMV reactivation can mimic an SLE flare and lead to delay in diagnosis. Here, we reported a previously diagnosed SLE patient who presented with fever, leukopenia, and cutaneous ulcers. Initially, this was diagnosed as an SLE flare and the patient was treated with higher doses of corticosteroids but no improvement was observed. Both nuclear and cytoplasmic inclusions inside the endothelial cells in the skin biopsy as well as positive immunohistochemistry (IHC) staining for CMV antigen were clues to the correct diagnosis of CMV reactivation. Treatment with ganciclovir resulted in clinical resolution. In this report, a very rare clinical form of CMV infection manifesting as cutaneous necrotizing vasculitis on the lower extremity is described and the literature regarding this case is reviewed.
系统性红斑狼疮（SLE）是一种慢性自身免疫性疾病，在其病程中可并发巨细胞病毒（CMV）感染。CMV 再激活可模拟 SLE 发作，导致诊断延迟。在这里，我们报告了一例先前诊断为 SLE 的患者，其表现为发热、白细胞减少和皮肤溃疡。最初，这被诊断为 SLE 发作，患者接受了更高剂量的皮质类固醇治疗，但没有观察到改善。皮肤活检中内皮细胞内的核内和胞质内包涵体以及 CMV 抗原的阳性免疫组化（IHC）染色均提示 CMV 再激活的正确诊断。更昔洛韦治疗导致临床缓解。在本报告中，描述了一种非常罕见的 CMV 感染的临床形式，表现为下肢皮肤坏死性血管炎，并回顾了该病例的文献。
