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Chlorambucil-induced cytomegalovirus infection: a case report
María Thiscal López-Lluva1, María Dolores Sanchez de la Nieta-García, Jesús Piqueras-Flores
1Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Calle del Obispo Rafael Torija s/n, 13005 Ciudad Real, España. mtl.lluva@gmail.com.
Introduction:
Chlorambucil is an alkylating agent used in combination with prednisolone for the treatment of idiopathic membranous nephropathy. Although chlorambucil is generally well-tolerated, it is a myelosuppresive drug that can cause several infections.
Case Presentation:
We report the case of an 81-year-old Caucasian male presenting with idiopathic membranous nephropathy who developed fever, cough, dyspnea, pulmonary infiltrates, and abdominal pain shortly after the initiation of treatment with chlorambucil and corticosteroids for nephropathy. Virology tests for infectious diseases revealed a recent cytomegalovirus infection. Antiviral treatment (ganciclovir) resulted in full remission.
Conclusions:
Cytomegalovirus infection should be considered in the differential diagnosis of respiratory symptoms and pulmonary infiltrates in patients treated with chlorambucil for nephrotic syndrome.
Insights
Cytomegalovirus infection can manifest with respiratory symptoms in patients treated with chlorambucil for idiopathic membranous nephropathy. Prompt antiviral treatment with ganciclovir led to full remission in a reported case.
Area of Science:
- Nephrology
- Infectious Diseases
- Oncology
Background:
- Idiopathic membranous nephropathy is often treated with chlorambucil and corticosteroids.
- Chlorambucil, an alkylating agent, is generally well-tolerated but can cause myelosuppression and infections.
Observation:
- An 81-year-old male with idiopathic membranous nephropathy developed fever, cough, dyspnea, pulmonary infiltrates, and abdominal pain after starting chlorambucil and corticosteroids.
- Virology tests confirmed a recent cytomegalovirus (CMV) infection.
Findings:
- The patient's symptoms, including respiratory distress and pulmonary infiltrates, were attributed to cytomegalovirus infection.
- Antiviral therapy with ganciclovir resulted in complete resolution of symptoms and remission.
Implications:
- Cytomegalovirus infection should be considered in the differential diagnosis of patients on chlorambucil therapy presenting with respiratory symptoms and pulmonary infiltrates.
- Early recognition and treatment of CMV infection are crucial for managing complications in patients undergoing immunosuppressive therapy for nephrotic syndrome.
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