Cytomegalovirus infection in systemic necrotizing vasculitis: causative agent or opportunistic infection?

• Published in: Rheumatology international 2000-12, Vol.20 (1), p.35-38
• Main Authors: MEYER, M. F, HELLMICH, B, KOTTERBA, S, SCHATZ, H
• Format: Article
• Language: English
• Subjects: Aged; Antibodies, Antineutrophil Cytoplasmic - blood; Antibodies, Viral - administration & dosage; Antibodies, Viral - blood; Biological and medical sciences; Cytomegalovirus - genetics; Cytomegalovirus - immunology; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - pathology; Diagnosis, Differential; DNA, Viral - analysis; Female; Ganciclovir - therapeutic use; Human viral diseases; Humans; Immunoglobulins - administration & dosage; Immunoglobulins - blood; Infections; Infectious diseases; Medical research; Medical sciences; Miscellaneous; Necrosis; Opportunistic Infections - etiology; Opportunistic Infections - pathology; Polyarteritis Nodosa - blood; Polyarteritis Nodosa - diagnosis; Polymerase Chain Reaction; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Vasculitis - drug therapy; Vasculitis - etiology; Vasculitis - pathology; Viral diseases
• ISSN: 0172-8172; 1437-160X
• DOI: 10.1007/s002960000063

We report on a 69-year-old woman who presented with myalgia, hearing impairment, fever, night sweats, weight loss, muscular weakness, paresthesia, hypesthesia, and hypalgesia. Sural nerve biopsy showed demyelinative and axonal polyneuropathy due to necrotizing vasculitis with fibrinoid necrosis. A positive test for antineutrophil cytoplasmic antibodies (ANCA) with a perinuclear immunofluorescence pattern directed against myeloperoxidase was more suggestive of microscopic polyangiitis (MPA) than of polyarteritis nodosa (PAN), the possible differential diagnoses. In addition, positive tests for cytomegalovirus (CMV) antibodies (immunoglobulin (Ig)M and IgG) and the detection of CMV-DNA in sputum specimens by polymerase chain reaction (PCR) were indicative of active CMV infection. Treatment with ganciclovir and anti-CMV immunoglobulin in addition to prednisolone medication for 6 months resulted in rapid improvement of the clinical symptoms without relapse. CMV infection has been described to be related to ANCA-associated vasculitis in non-immunocompromized patients and may be either a causative agent or an opportunistic infection. Identification of a viral etiology in patients with atypical ANCA-associated vasculitides may lead to different, less aggressive treatment approaches, including antiviral therapy.