Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Medicine, King Saud University, Riyadh, Saudi Arabia.
J Med Case Rep. 2022 Jan 31;16(1):58. doi: 10.1186/s13256-022-03259-0.
The effect of coronavirus disease 2019 on the immune system is increasingly recognized. When severe, it causes immune dysregulation that may favor other infections, including Herpesviridae. Cytomegalovirus shares many innate immune pathways with severe acute respiratory syndrome coronavirus 2, which may potentiate each other. We describe a case of cytomegalovirus pneumonitis complicating the course of coronavirus disease 2019 in a patient with systemic lupus erythematosus/systemic sclerosis overlap and usual interstitial pneumonia, mimicking interstitial lung disease exacerbation. To the best of the authors' knowledge, this is the first case to be reported worldwide in the setting of connective tissue disease-associated interstitial lung disease.
We describe the case of a 47-year-old white/Yemeni female who is known to have systemic lupus erythematosus/scleroderma overlap and usual interstitial pneumonia who was initially admitted with severe coronavirus disease 2019 pneumonia mandating intensive care. After initial improvement, it was later complicated with cytomegalovirus pneumonitis, mimicking interstitial lung disease exacerbation. The case was successfully treated with ganciclovir.
Intriguingly, severe acute respiratory syndrome coronavirus 2 and cytomegalovirus may potentiate each other, since they share some innate immune pathways. Subjects with severe coronavirus disease 2019 and underlying connective tissue diseases and those who are immunosuppressed carry higher risk compared with other cohorts, which may mandate active surveillance for cytomegalovirus coinfection or reactivation. Among various immunosuppressive therapies that has been tried for cytokine storm, use of anti-interleukin-6 inhibitors in the aforementioned population may carry more harm than previously thought, which may suggest that is reasonable to omit its use in treating this group with coronavirus disease 2019. This case underlines an underrecognized and underreported cause of morbidity and mortality during the course of severe coronavirus disease 2019 and will help to alert clinicians of its occurrence.
越来越多的人认识到 2019 年冠状病毒病（COVID-19）对免疫系统的影响。在严重的情况下，它会导致免疫失调，从而可能有利于其他感染，包括疱疹病毒科。巨细胞病毒与严重急性呼吸综合征冠状病毒 2 共享许多先天免疫途径，这可能会相互促进。我们描述了一例系统性红斑狼疮/系统性硬化症重叠并伴有寻常型间质性肺炎的患者，在 COVID-19 病程中并发巨细胞病毒肺炎，模仿间质性肺病恶化。据作者所知，这是全球首例在结缔组织病相关间质性肺病背景下报告的病例。
我们描述了一位 47 岁的白人/也门女性，患有系统性红斑狼疮/系统性硬化症重叠和寻常型间质性肺炎，最初因严重的 COVID-19 肺炎需要入住重症监护病房。在最初的病情改善后，她后来并发了巨细胞病毒肺炎，模仿间质性肺病恶化。该病例成功地用更昔洛韦治疗。
有趣的是，严重急性呼吸综合征冠状病毒 2 和巨细胞病毒可能会相互促进，因为它们共享一些先天免疫途径。与其他队列相比，患有严重 COVID-19 的患者和潜在的结缔组织疾病以及免疫抑制的患者具有更高的风险，这可能需要对巨细胞病毒合并感染或再激活进行主动监测。在各种用于细胞因子风暴的免疫抑制治疗中，在上述人群中使用抗白细胞介素-6 抑制剂可能比以前认为的危害更大，这可能表明在治疗 COVID-19 时合理地避免使用该药物。该病例强调了严重 COVID-19 病程中发病率和死亡率的一个未被充分认识和报告的原因，并将有助于提醒临床医生注意其发生。
