The clinical features and mortality risk factors of cytomegalovirus infection in patients with systemic lupus erythematosus

• Main Authors: MingLi Hung, Deh-Feng Huang, Wei-Sheng Chen, Chien-Chih Lai, Ming-Han Chen, Hsien-Tzung Liao, Chang-Youh Tsai
• Format: Article
• Language: English
• Published: Elsevier 2019-02-01
• Series: Journal of Microbiology, Immunology and Infection
• Online Access: http://www.sciencedirect.com/science/article/pii/S1684118218301208

Background: The clinical features and outcomes of cytomegalovirus (CMV) diseases in patients with systemic lupus erythematosus (SLE) are unknown. We analyzed such data from a medical center in Taiwan. Methods: We retrospectively reviewed the medical records of patients with SLE who were diagnosed with CMV diseases between 2006 and 2016 in Taipei Veterans General Hospital Taiwan. Clinical and laboratory parameters and treatment outcomes were analyzed. Results: The study enrolled 56 eligible patients with CMV diseases and separated them into survival (n = 24) and mortality (n = 32) groups. All cases showed a significantly high incidence of pneumonitis (71.43%). The patients in the mortality group had a higher SLE disease activity index (SLEDAI)-2000 (p = 0.009), more cases of recent methylprednisolone pulse therapy (p = 0.013) and pancytopenia (p = 0.001), stronger evidence of CMV infection demonstrated by polymerase chain reaction (PCR) in blood (p < 0.001) and bronchoalveolar lavage (p = 0.021), and more concurrent infections (bacteremia p = 0.026; fungemia p < 0.001). Conclusions: Recent pulse therapy, pancytopenia, and concurrent infections constituted risk factors for mortality in patients with SLE and CMV infection. Among mortality patients, PCR rather than serological tests (IgM antibodies) helped to arrive at an earlier diagnosis. Keywords: Systemic lupus erythematosus, Cytomegalovirus, Pneumonitis, Acute respiratory distress syndrome