Disseminated Intravascular Coagulation Induced by Generalized Cytomegalic Inclusion Disease During Steroid Therapy for Polymyositis

Abstract

A 56‐year‐old woman came to the hospital with fever and skin eruptions. A rise in myogenic enzyme and the presence of antileucocyte antibody were noticed, along with the gradual appearance of myalgia in both lower extremities, and muscle weakness. Steroid therapy was started under the diagnosis of polymyositis. The steroid was reduced because of mental disturbance but immediately the patient developed high fever. Various forms of treatment were carried out but there was no improvement, and the patient died. At autopsy there were scattered purpura on the skin, and the muscles were atrophic and yellowish‐grey in color. Histopathologically, there was inflammatory cell infiltration and muscle fiber degeneration visible in many of the muscles, and the findings showed evidence of polymyositis. There were intranuclear inclusions in the lungs, ovaries, and adrenal glands, and this was diagnosed as generalized cytomegalic inclusion disease. Fibrin thrombi were found in the kidneys, lungs, and adrenal glands and this was pathologically diagnosed as disseminated intravascular coagulation. Endothelial cell damage caused by cytomegalovirus was assumed to be involved to a large extent in triggering the disseminated intravascular coagulation. ACTA PATHOL. JPN. 35: 723–730, 1985.

Silent oophoritis due to cytomegalovirus in a patient with advanced HIV disease

“…Case reports of CMV orchitis, epididymitis, and ovaritis have been anecdotally recorded in patients with haematological or solid malignancies, bone marrow or organ transplantation 1± 8 , as well as in patients undergoing immunosuppressive treatment for collagen vascular disease 9 , but are still rare in the setting of HIV disease 10± 17 .…”

Disseminated Intravascular Coagulation Associated With Systemic Cytomegalovirus Infection During Cyclosporine Therapy for Ulcerative Colitis: Report of a Case

“…1 In fact, damage of microvascular endothelium, vasculitis, thrombotic occlusion, and hemorrhages have been observed in both patients with generalized CMV infection and rat experimental CMV infection models. 17,18 Exacerbation of our patient's colitis was followed by clinical manifestation of DIC and the appearance of CMV antigenemia before he underwent surgical resection of the affected colon. This condition was assumed to be caused by systemic CMV infection because intravenous ganciclovir was effective.…”

Disseminated intravascular coagulation associated with cytomegalovirus infection in a patient with hepatitis C virus cirrhosis

“…There have been only a few reported cases of severe blood coagulation disorders occurring during human cytomegalovirus (CMV) infection and most of them involved immunosuppressed patients 1–5 . Cirrhotic patients suffer various grades of immunosuppression 6 and are at risk for CMV infection, which has been considered to be mild and asymptomatic 7 .…”

“…Experimental evidence suggests that CMV can infect endothelial cells causing coagulation abnormalities compatible with DIC 9 . In humans, CMV infection leading to DIC has been reported in association with immunocompromised conditions, 1–3 and has been reported twice in apparently immunocompetent patients 4,5 . The dysregulation of cellular immunity may induce a state of immunosuppression in cirrhotic patients, 6 which predisposes to CMV reactivation.…”