Cytomegalovirus as a trigger for systemic lupus erythematosus

Abstract

Cytomegalovirus (CMV) infections have been associated with exacerbations of systemic lupus erythematosus (SLE). Their role in triggering this disease, however, remains a subject of debate. We present a 43-year-old man with no history of systemic illness who developed persistent signs and symptoms of a CMV-associated mononucleosis-like syndrome while fulfilling diagnostic criteria for previously undiagnosed SLE. The patient was admitted with persistent fever for 3 weeks, cervical lymphadenopathy, elevated liver function tests, and leukopenia. Further laboratory studies revealed positive antinuclear antibody, anti-dsDNA, anti-Sm/RNP, rheumatoid factor, and anticardiolipin antibodies along with decreased complement levels and proteinuria of 876 mg/dL. CMV immunoglobulin M was positive in the absence of CMV immunoglobulin G, supporting acute CMV infection. Symptoms improved with intravenous administration of methylprednisolone and ganciclovir therapy. Mechanisms by which CMV may trigger autoimmunity have been proposed, and this case could support CMV infection as a potential trigger for SLE in susceptible individuals.