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[Three patients with systemic lupus erythematosus complicated by cytomegalovirus colitis]
Insights
High-dose corticosteroids in lupus patients can lead to cytomegalovirus (CMV) colitis, causing intestinal bleeding. Ganciclovir effectively treated CMV colitis in these cases, even without reducing steroid dosage.
Area of Science:
- Immunology
- Gastroenterology
- Infectious Diseases
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease.
- High-dose corticosteroid therapy is often used for severe SLE manifestations.
- Complications during immunosuppression require careful monitoring.
Observation:
- Three female patients with SLE experienced massive intestinal hemorrhage.
- Hemorrhage occurred during recovery from lupus nephritis or central nervous system lupus.
- Patients were on high-dose corticosteroid therapy.
Findings:
- Cytomegalovirus (CMV) antigen-positive leukocytes were abundant in the affected patients.
- Ganciclovir therapy led to cessation of bleeding and disappearance of viral antigens.
- CMV colitis was diagnosed in all three patients.
- Ganciclovir treatment was effective without requiring a reduction in corticosteroid dosage.
- No recurrence of symptoms was observed.
Implications:
- CMV colitis is a potential complication of high-dose corticosteroid therapy in SLE patients.
- Ganciclovir is an effective treatment for CMV colitis in this context.
- Early diagnosis and treatment of CMV colitis can prevent severe gastrointestinal bleeding.
- Management of CMV colitis may not necessitate altering the immunosuppressive steroid regimen.
Abstract:
We report three female patients with systemic lupus erythematosus complicated by massive intestinal hemorrhage during the recovery from lupus nephritis (case 1, 2) or central nervous system lupus (case 3) on high dose corticosteroid therapy. Large number of cytomegalovirus (CMV) antigen-positive leukocytes and cessation of bleeding with concurrent disappearance of the viral antigens after ganciclovir therapy indicated CMV colitis in all of the three patients. No recurrence of the symptom and a favorable response to ganciclovir without reduction in steroid regimen was common to these patients.