Pp65 antigenemia and cytomegalovirus diagnosis in patients with lupus nephritis: report of a series.

Lino, Katia; Trizzotti, Natalia; Carvalho, Fabiana Rabe; Cosendey, Rachel Ingrid Juliboni; Souza, Cintia Fernandes; Klumb, Evandro Mendes; Silva, Andréa Alice; Almeida, Jorge Reis

doi:10.1590/2175-8239-jbn-3838

Cited by 8 publications

(4 citation statements)

References 38 publications

(42 reference statements)

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“…In our study, CMV viral load at admission was not significantly correlated with final outcomes. CMV reactivation and risk for CMV disease possibly related with a subjacent immunosuppressive status may occur as in systemic lupus erythematous or in organ transplant 14 , 15 ; however, characteristics of latency and reactivation of the herpes family should be better monitored in the critically ill COVID-19 patients. For example, many of the reported cases and series of CMV-associated to cytokine storm syndromes involve viral reactivation during immune suppressed states.…”

Section: Discussionmentioning

confidence: 99%

Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality

Lino¹,

Guimarães²,

Alves³

et al. 2021

The Brazilian Journal of Infectious Diseases

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Section: Discussionmentioning

confidence: 99%

Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality

Lino¹,

Guimarães²,

Alves³

et al. 2021

The Brazilian Journal of Infectious Diseases

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“…Although we initiated treatment with ganciclovir and could see an improvement in the C7-HRP test results, the patient’s colitis symptoms did not improve. The specificity of positive CMV antigenemia for diagnosing CMV colitis is high, and the progressive reduction of antigen titers is associated with therapeutic effects[ 11 , 12 ]. In our case, we should have considered amebic colitis because of the discrepancy between the successful lowering of the CMV antigen titers and the unabated colitis symptoms.…”

Section: Discussionmentioning

confidence: 99%

Fulminant amebic colitis in a patient with concomitant cytomegalovirus infection after systemic steroid therapy: A case report

Shijubou¹,

Sumi²,

Kamada³

et al. 2021

WJCC

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BACKGROUND Amebic colitis is an infection caused by Entamoeba histolytica and most commonly observed in regions with poor sanitation. It is also seen as a sexually transmitted disease in developed countries. While amebic colitis usually has a chronic course with repeated exacerbations and remissions, it may also manifest as a fulminant form that rapidly progresses and leads to severe, life-threatening complications, such as intestinal perforation, peritonitis, and sepsis, that have a high mortality rate. CASE SUMMARY A 68-year-old man was admitted to our hospital with chest pain and acute dyspnea. He was diagnosed with acute coronary syndrome, acute heart failure, and bacterial pneumonia. His respiratory condition worsened despite receiving intensive care and intravenous antibiotics. On the fifth day of hospitalization, he was diagnosed with acute respiratory distress syndrome and was started on steroid therapy. He subsequently developed bloody stools and was diagnosed with cytomegalovirus (CMV) enterocolitis based on biopsy results and a peripheral blood CMV pp65 antigenemia test result. Although we started antiviral therapy with ganciclovir, which was successful in reducing his antigen titers, he continued to have bloody diarrhea. Three weeks after initiation of ganciclovir therapy and six weeks after his admission, the patient died from intestinal perforation. We only posthumously diagnosed him with amebic colitis and CMV enterocolitis based on autopsy findings of transmural necrosis of the entire colon with massive ameba infiltration. CONCLUSION We urge clinicians to consider Entamoeba histolytica infection if severe colitis progresses after steroid therapy. Preemptive treatment is recommended then.

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“…CMV is an important opportunistic pathogen that causes morbidity and mortality in immunocompromised patients, leading to symptoms such as fever, interstitial pneumonia, enteritis, hepatitis, retinitis, and encephalitis. CMV infection can be assessed through a variety of techniques, including serology and histopathology for detection of viral components, among which phosphorylated protein 65 (PP65 antigenemia), which is abundantly present in viral fragments, is detected in peripheral blood leukocytes by indirect immunofluorescence, and for which early monitoring is indicated for patients with SLE and other diseases requiring immunosuppressive therapy [12]. The present patient had been treated with ganciclovir for CMV infection since the time of admission, and her CMV pp65 continued to decline without leukopenia, despite her worsening condition.…”

Section: Discussionmentioning

confidence: 99%

Fatal outcome in a patient under immunosuppressant therapy infected with human T-lymphotropic virus type 1 (HTLV-1), cytomegalovirus (CMV) and Strongyloides stercoralis: a case report

et al. 2020

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Background Strongyloidiasis is a gastrointestinal parasitic infection caused by percutaneous infection with Strongyloides stercoralis. Digestive symptoms such as diarrhea and abdominal pain are the main manifestation, but serious infections such as septicemia, purulent meningitis, and bacterial pneumonia may occur in individuals harboring human T-lymphotropic virus type 1 (HTLV-1) or who are immunocompromised. Although coinfection with Strongyloides stercoralis and HTLV-1 can lead to chronic strongyloidiasis and a disseminated form of the disease, there is a high rate of response to the anthelmintic ivermectin. Case presentation We report a case of strongyloidiasis infection syndrome that was difficult to differentiate from immune reconstitution inflammatory syndrome (IRIS) for various reasons. The patient had been treated with the corticosteroids tacrolimus (Tac) and mycophenolate mofetil (MMF) for systemic lupus erythematosus (SLE) with lupus nephritis and pancytopenia. When the steroid was reduced, she developed cytomegalovirus (CMV) enteritis, and her respiratory status rapidly deteriorated immediately after the withdrawal of Tac and MMF. It was difficult to distinguish immune reconstitution inflammatory syndrome from strongyloidiasis infection syndrome because stool cultures were negative and eosinophils were not increased. Bronchoscopy revealed viable Strongyloides, leading to a diagnosis of strongyloidiasis infection syndrome, but the patient died despite treatment. Conclusions Both corticosteroid therapy and HTLV-1 infection can be associated with a decrease of eosinophils, despite the presence of parasitic infection. In conclusion, even if multiple culture tests are negative, the risk of parasitic infection should be assessed in patients receiving immunosuppressants and steroids even in non-endemic areas.

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Pp65 antigenemia and cytomegalovirus diagnosis in patients with lupus nephritis: report of a series.

Abstract: Pp65 antigenemia might be relevant in SLE patients, and studies with a greater number of patients are needed in order to establish sensitivity and specificity of pp65 antigenemia in different clinical contexts of SLE patients.

Cited by 8 publications

References 38 publications

Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality

Serum ferritin at admission in hospitalized COVID-19 patients as a predictor of mortality

Fulminant amebic colitis in a patient with concomitant cytomegalovirus infection after systemic steroid therapy: A case report

Fatal outcome in a patient under immunosuppressant therapy infected with human T-lymphotropic virus type 1 (HTLV-1), cytomegalovirus (CMV) and Strongyloides stercoralis: a case report

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