Sato Shinichi, Takahashi Masato, Takahashi Tetsu
Oral and Maxillofacial Surgery, Japan Community Health Care Organization Sendai Hospital, 3-16-1 Tsutsumimachi, Aoba-ku, Sendai 981-8501, Japan.
Division of Oral and Maxillofacial Surgery, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-Ku, Sendai 980-8575, Japan.
Case Rep Dent. 2020 Sep 29;2020:8843816. doi: 10.1155/2020/8843816. eCollection 2020.
We report a case of cytomegalovirus- (CMV-) induced buccal ulcer in a patient with nephrotic syndrome. An 82-year-old man with membranous nephropathy was on immunosuppressive therapy presented with an ulcer in the oral cavity and was hospitalized. Intraoral examination revealed an inflamed and painful ulcer on the left buccal mucosa. Blood test results showed CMV positivity, and histopathological examination confirmed the diagnosis. Anti-CMV therapy (ganciclovir) was initiated from the third day of hospitalization. However, he developed dyspnea on the 14th day. Computed tomography images of the chest revealed the presence of ground-glass opacities, and noninvasive positive pressure ventilation was initiated under the provisional diagnosis of pneumocystis pneumonia caused by ganciclovir-associated myelosuppression and/or steroid-induced immunocompromised state. The patient died of pneumocystis pneumonia on the 21st day. The patient had received immunosuppressive therapy for renal dysfunction. Immunocompromised patients with CMV infection should be treated with caution, as drugs for CMV may themselves cause myelosuppression, deteriorating the prognosis of the patient.
我们报告一例肾病综合征患者因巨细胞病毒（CMV）感染引起的口腔溃疡病例。一名82岁患有膜性肾病且正在接受免疫抑制治疗的男性，因口腔出现溃疡而住院。口腔检查发现左侧颊黏膜有一处发炎且疼痛的溃疡。血液检测结果显示CMV呈阳性，组织病理学检查确诊了该疾病。从住院第三天开始进行抗CMV治疗（更昔洛韦）。然而，他在第14天出现了呼吸困难。胸部计算机断层扫描图像显示有磨玻璃样阴影，在初步诊断为更昔洛韦相关骨髓抑制和/或类固醇诱导的免疫功能低下状态导致的肺孢子菌肺炎后，开始进行无创正压通气。患者于第21天死于肺孢子菌肺炎。该患者因肾功能不全接受了免疫抑制治疗。免疫功能低下的CMV感染患者应谨慎治疗，因为用于治疗CMV的药物本身可能会引起骨髓抑制，从而恶化患者的预后。
