Clinical Characteristics Of Cytomegalovirus Active Infection In Patients With Systemic Lupus Erythematosus Fever

Background:Human cytomegalovirus (HCMV) infection is ubiquitous throughout the world, and HCMV is one of the most commonly occurring opportunistic infections in patients with systemic lupus erythematosis (SLE). Fever, frequently presented in patients with active SLE and HCMV infection, makes it hard to make differential diagnosis.Objective:To understand the key role of HCMV infection played in the pathogenesis and development of SLE, we analyzed the clinical characteristics and immunologic changes of active HCMV infection in SLE patients, and identified major risk factors, for lupus patients suffering from HCMV infection.Methods:The medical records of1783consecutive patients hospitalised for SLE from January2007to June2012were reviewed. A total of366SLE-hospitalised patients with fever were screened and retrospectively analyzed, and the levels of Thl/Th2/Thl7type interleukins in30patients were measured.Results:Among366SLE patients with fever,186cases were caused by both SLE activity and infections,133were related to active SLE, and43were infections.117out of366had HCMV infection. HCMV was most likely to infect new-onset lupus patients who presented serous effusion, smooth muscle involvement, liver dysfunction, high SLEDAI scores, lymphocytopenia, low CD4+T-cell count, high levels of24-hour proteinuria, low serum complements and elevated anti-dsDNA antibody levels. HCMV exacerbating SLE patients tended to have lymphocytopenia and high levels of24-hour proteinuria. HCMV infection in retreatment SLE patients was found to be associated with the leukopenia, lymphocytopenia, high SLEDAI scores, high levels of24-hour proteinuria and the use of cyclophosphamide within the last six months. Compared to SLE patients without infection the levels of IL-17in HCMV infected SLE significantly decreased, while the levels of IL-10revealed increase.Conclusion:One-third of SLE with fever had active HCMV infection. New-onset SLE and severe SLE are prone to HCMV infection, which suggested that HCMV might be an etiologic factor in lupus. HCMV infections tend to exacerbate lupus in both initial and retreatment patients. Leukopenia, lymphocytopenia, high SLEDAI scores, high levels of24-hour proteinuria and the use of cyclophosphamide are risk factors for SLE patients susceptible to HCMV. The changes of interleukin-17related to Th17might give explanation of why SLE patients are easily suffering from HCMV infection.