Cytomegalovirus Infection Mimics Manifestations of Underlying Diseases in Patients With Autoimmune Disorders: A Case Report and Literature Review.

BACKGROUND

Patients with autoimmune disorders are highly susceptible to infections including cytomegalovirus (CMV) leading to serious complications ranging from asymptomatic to severe systemic diseases.

CASE PRESENTATION: The first case was a 44-year-old woman with systemic lupus erythematosus (SLE) referred to the Rheumatology ward due to a necrotizing ulcer on the hand's finger and multiple ulcerative lesions on her lips and tongue. She had pancytopenia and tested positive for both herpes simplex virus (HSV) and CMV polymerase chain reaction (CMV-PCR). She was treated with ganciclovir for 14 days and subsequently recovered. The second case was a 55-year-old man, a known sarcoidosis case, admitted to the hospital due to lower extremities weakness and intraoral ulcers. The lab findings revealed leukopenia and elevated levels of ESR and CRP. Viral markers were all negative except for the CMV-PCR test. Electromyography and nerve conduction velocity (EMG-NCV) showed subacute axonal motor polyneuropathy in the lower limbs. Due to the high titers of CMV (500,000 copies/mL), he was treated with ganciclovir for 2 weeks and the symptoms improved dramatically.

CONCLUSION

CMV infection in patients with inflammatory rheumatic diseases may lead to rare manifestations that can be misdiagnosed as a flare of the underlying disease.