Cytomegalovirus Infection in Childhood-onset Systemic Lupus Erythematosus

Overview

Journal Int J Clin Rheumtol

Publisher Future Medicine

Specialty Rheumatology

Date 2014 Feb 15

PMID 24527062

Citations 12

Authors

Evelyn V Rozenblyum

Upton D Allen

Earl D Silverman

Deborah M Levy

Affiliations

Soon will be listed here.

Abstract

Systemic lupus erythematosus (SLE) is a multisystem disease with significant morbidity and even mortality. (CMV) is a ubiquitous herpesvirus that, similar to SLE, can also lead to significant morbidity and mortality in the immunocompromised host. The relationship between SLE and CMV is complex, with observations suggesting that CMV induces the autoimmunity of SLE in addition to occurring in the immunocompromised host with known SLE. In this article, we first consider CMV infection in the immunocompetent host, and further examine how this infection differs in the patient with SLE. We focus on disease mechanisms, CMV detection and treatment. We review the differences between CMV infection, syndrome and disease, as identifying the correct state will determine the appropriate treatment. We propose guidelines for the screening and management of CMV infection in childhood-onset SLE, and recognize that further study in this population is required to increase our understanding of the interplay between these disease entities.

Citing Articles

Why is it so difficult to understand why we don't understand human systemic lupus erythematosus? Contemplating facts, conflicts, and impact of "the causality cascade paradigm".

Rekvig O Front Immunol. 2025; 15:1507792.

PMID: 39936150 PMC: 11811100. DOI: 10.3389/fimmu.2024.1507792.

Clinical features and prognosis of systemic lupus erythematosus complicated by active cytomegalovirus infection: a retrospective cohort study.

Chen Y, Zhang L, Liu Y, Liu Y, Zhao L, Zhou B Front Immunol. 2024; 15:1323923.

PMID: 38481991 PMC: 10932949. DOI: 10.3389/fimmu.2024.1323923.

T-Cell Receptor Sequences Identify Combined Coxsackievirus- Infections as Triggers for Autoimmune Myocarditis and Coxsackievirus- Infections for Type 1 Diabetes.

Root-Bernstein R Int J Mol Sci. 2024; 25(3).

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, Neurodegenerative Disorders and Autoimmune Diseases: What Is the Relationship between Them?.

De Francesco M Viruses. 2024; 16(1).

PMID: 38257833 PMC: 10818483. DOI: 10.3390/v16010133.

Clinical phenotypes and prognosis of cytomegalovirus infection in the pediatric systemic lupus erythematosus: a longitudinal analysis.

Zhang T, Yu Z, Gao S, Zhang Y, Wang C, Jian S Pediatr Rheumatol Online J. 2023; 21(1):25.

PMID: 36927380 PMC: 10022138. DOI: 10.1186/s12969-023-00807-w.

References

Doria A, Zampieri S, Sarzi-Puttini P . Exploring the complex relationships between infections and autoimmunity. Autoimmun Rev. 2008; 8(2):89-91. DOI: 10.1016/j.autrev.2008.07.036. View

Ramos-Casals M, Cuadrado M, Alba P, Sanna G, Brito-Zeron P, Bertolaccini L . Acute viral infections in patients with systemic lupus erythematosus: description of 23 cases and review of the literature. Medicine (Baltimore). 2008; 87(6):311-318. DOI: 10.1097/MD.0b013e31818ec711. View

Hsieh A, Jhou Y, Liang C, Chang M, Wang S . Fragment of tegument protein pp65 of human cytomegalovirus induces autoantibodies in BALB/c mice. Arthritis Res Ther. 2011; 13(5):R162. PMC: 3308095. DOI: 10.1186/ar3481. View

Fujimoto D, Matsushima A, Nagao M, Takakura S, Ichiyama S . Risk factors associated with elevated blood cytomegalovirus pp65 antigen levels in patients with autoimmune diseases. Mod Rheumatol. 2012; 23(2):345-50. DOI: 10.1007/s10165-012-0651-8. View

Baboonian C, Venables P, Booth J, Williams D, Roffe L, Maini R . Virus infection induces redistribution and membrane localization of the nuclear antigen La (SS-B): a possible mechanism for autoimmunity. Clin Exp Immunol. 1989; 78(3):454-9. PMC: 1534804. View

Nawata M, Seta N, Yamada M, Sekigawa I, Lida N, Hashimoto H . Possible triggering effect of cytomegalovirus infection on systemic lupus erythematosus. Scand J Rheumatol. 2002; 30(6):360-2. DOI: 10.1080/030097401317148570. View

Murakami H, Takahashi S, Kawakubo Y, Kinukawa N, Funaki S, Harada K . Adolescent with Henoch-Schönlein purpura glomerulonephritis and intracranial hemorrhage possibly secondary to the reactivation of latent CMV. Pediatr Int. 2008; 50(1):112-5. DOI: 10.1111/j.1442-200X.2007.02531.x. View

Takizawa Y, Inokuma S, Saito K, Atsumi T, Hirakata M, Kameda H . Clinical characteristics of cytomegalovirus infection in rheumatic diseases: multicentre survey in a large patient population. Rheumatology (Oxford). 2008; 47(9):1373-8. DOI: 10.1093/rheumatology/ken231. View

Bego M, St Jeor S . Human cytomegalovirus infection of cells of hematopoietic origin: HCMV-induced immunosuppression, immune evasion, and latency. Exp Hematol. 2006; 34(5):555-70. DOI: 10.1016/j.exphem.2005.11.012. View

10.

Barber C, Gold W, Fortin P . Infections in the lupus patient: perspectives on prevention. Curr Opin Rheumatol. 2011; 23(4):358-65. DOI: 10.1097/BOR.0b013e3283476cd8. View

11.

Boeckh M, Leisenring W, Riddell S, Bowden R, Huang M, Myerson D . Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood. 2002; 101(2):407-14. DOI: 10.1182/blood-2002-03-0993. View

12.

Hrycek A, Kusmierz D, Mazurek U, Wilczok T . Human cytomegalovirus in patients with systemic lupus erythematosus. Autoimmunity. 2005; 38(7):487-91. DOI: 10.1080/08916930500285667. View

13.

Kelesidis T, Daikos G, Boumpas D, Tsiodras S . Does rituximab increase the incidence of infectious complications? A narrative review. Int J Infect Dis. 2010; 15(1):e2-16. PMC: 8053444. DOI: 10.1016/j.ijid.2010.03.025. View

14.

Palafox Sanchez C, Satoh M, Chan E, Carcamo W, Munoz Valle J, Orozco Barocio G . Reduced IgG anti-small nuclear ribonucleoprotein autoantibody production in systemic lupus erythematosus patients with positive IgM anti-cytomegalovirus antibodies. Arthritis Res Ther. 2009; 11(1):R27. PMC: 2688261. DOI: 10.1186/ar2621. View

15.

Perdan-Pirkmajer K, Koren-Kranjc M, Tomsic M . A successfully treated pancreatitis caused by a CMV infection in a lupus patient. Lupus. 2011; 20(10):1104-5. DOI: 10.1177/0961203311398514. View

16.

Akagi S, Ichikawa H, Suzuki J, Makino H . Systemic lupus erythematosus associated with cytomegalovirus infection. Scand J Rheumatol. 2004; 33(1):58-9. DOI: 10.1080/03009740410005331. View

17.

Yoda Y, Hanaoka R, Ide H, Isozaki T, Matsunawa M, Yajima N . Clinical evaluation of patients with inflammatory connective tissue diseases complicated by cytomegalovirus antigenemia. Mod Rheumatol. 2006; 16(3):137-42. DOI: 10.1007/s10165-006-0470-x. View

18.

Boeckh M, Boivin G . Quantitation of cytomegalovirus: methodologic aspects and clinical applications. Clin Microbiol Rev. 1998; 11(3):533-54. PMC: 88895. DOI: 10.1128/CMR.11.3.533. View

19.

Strasser C, Wolf E, Kornprat P, Hermann J, Munch A, Langner C . Opportunistic cytomegalovirus infection causing colonic perforation in a patient with systemic lupus erythematosus. Lupus. 2011; 21(4):449-51. DOI: 10.1177/0961203311425529. View

20.

Razonable R, Paya C, Smith T . Role of the laboratory in diagnosis and management of cytomegalovirus infection in hematopoietic stem cell and solid-organ transplant recipients. J Clin Microbiol. 2002; 40(3):746-52. PMC: 120290. DOI: 10.1128/JCM.40.3.746-752.2002. View