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"apellidos" => "Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Germans Trias i Pujol, Badalona, Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] 1 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital Germans Trias i Pujol, Badalona, Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "affc" ] 2 => array:3 [ "entidad" => "Servicio de Nefrología. Servicio de Anatomía Patológica, Hospital Germans Trias i Pujol, Badalona, Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "affd" ] 3 => array:3 [ "entidad" => "Servicio de Endoscopia, Hospital Germans Trias i Pujol, Badalona, Barcelona, " "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "affe" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colitis por citomegalovirus" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10678_108_13124_en_10678_f1.jpg" "Alto" => 563 "Ancho" => 781 "Tamanyo" => 34582 ] ] "descripcion" => array:1 [ "en" => "Abdominal TC" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor, </span></p><p class="elsevierStylePara">Our patient was a Bolivian woman diagnosed with systemic lupus erythematosus (SLE) in 2003. In July 2008, she developed type IV lupus glomerulonephritis and treatment was started with i.v. methylprednisolone followed by oral prednisone at doses of 1mg/kg/day and mycophenolate mofetil (MMF). She was hospitalised for a month due to respiratory symptoms. <span class="elsevierStyleItalic">Nocardia</span><span class="elsevierStyleItalic">spp</span> were isolated from the sputum culture, antibiotic treatment begun and immunosuppressive medication was reduced.</p><p class="elsevierStylePara">During hospitalisation, the patient developed fever, abdominal pain, vomiting and diarrhoea. Culture studies, parasite study, identification of <span class="elsevierStyleItalic">Clostridium difficile</span> toxin and antigenaemia for cytomegalovirus (CMV) were performed on two occasions, and the results were negative. An abdominal CT (Figure 1) showed a thickening of the wall of the colon with occlusion of the lumen from the cecum to the rectum-sigmoid junction, which was compatible with diffuse pancolitis. A fibrocolonoscopy was requested (Figure 2), which revealed oedematous mucosa with multiple soft nodular lesions compatible with pneumatosis <span class="elsevierStyleItalic">coli</span>. The colon biopsy revealed viral inclusions which were confirmed for CMV by immunohistochemistry (Figure 3). The third antigenaemia determination for CMV was positive and the definitive diagnosis was CMV colitis. Treatment with i.v. ganciclovir was begun and the MMF treatment withdrawn, with clinical improvement and a negative antigenaemia for CMV.</p><p class="elsevierStylePara">SLE is a chronic autoimmune inflammatory disease of unknown cause with a wide variety of clinical presentations.</p><p class="elsevierStylePara">It is characterised by an alteration in the immune system which involves the synthesis of autoantibodies and the formation of immune complexes which cause tissue damage, along with the action of inflammatory mediators.</p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">Lupus disease itself and the use of immunosuppressive agents increase the risk of opportunistic infections causing increased morbidity and mortality. In general, patients have bacterial infections, however, there is an increase in viral infections, due especially to CMV, but also to human parvovirus b<span class="elsevierStyleInf">19</span>, simplex herpes, varicella zoster and hepatitis A.<span class="elsevierStyleSup">1</span></p><p class="elsevierStylePara">Viral infections may have symptoms identical to those of SLE, such as malaise, fever, arthralgia, a rash, lymphadenopathy and cytopaenias, so it may be confused with an outbreak of SLE.<span class="elsevierStyleSup">2,3</span> This may lead to increasing immunosuppressive therapy, thereby worsening the latent infection.</p><p class="elsevierStylePara">In our case, the patient developed an invasive CMV disease despite reducing the immunosuppressive treatment. The persistence of abdominal symptoms without encountering an infectious cause, the finding of non-specific lesions in the colonoscopy and reduced immunosuppression, made us suspect that it was an outbreak of SLE with abdominal affectation. The anatomopathological study allowed us to make the diagnosis of CMV colitis, and administer appropriate treatment to prevent further immunosuppression.</p><p class="elsevierStylePara">We believe it important to maintain a high degree of suspicion for both bacterial and viral opportunistic infections that mimic outbreaks of lupus disease in immunosuppressed patients. They will benefit from prompt diagnosis and appropriate treatment.</p><p class="elsevierStylePara"><a href="grande/10678_108_13124_en_10678_f1.jpg" class="elsevierStyleCrossRefs"><img src="10678_108_13124_en_10678_f1.jpg" alt="Abdominal TC"></img></a></p><p class="elsevierStylePara">Figure 1. Abdominal TC</p><p class="elsevierStylePara"><a href="grande/10678_108_13125_en_10678_f2.jpg" class="elsevierStyleCrossRefs"><img src="10678_108_13125_en_10678_f2.jpg" alt="Fibrocolonoscopy"></img></a></p><p class="elsevierStylePara">Figure 2. Fibrocolonoscopy</p><p class="elsevierStylePara"><a href="grande/10678_108_13126_en_10678_f3.jpg" class="elsevierStyleCrossRefs"><img src="10678_108_13126_en_10678_f3.jpg" alt="Colon biopsy"></img></a></p><p class="elsevierStylePara">Figure 3. Colon biopsy</p>" "pdfFichero" => "P1-E515-S2802-A10678-EN.pdf" "tienePdf" => true "PalabrasClave" => array:1 [ "en" => array:3 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441440" "palabras" => array:1 [ 0 => "Abdominal vasculitis" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441442" "palabras" => array:1 [ 0 => "Cytomegalovirus infection" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec441444" "palabras" => array:1 [ 0 => "Systemic lupus erythematosus" ] ] ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10678_108_13124_en_10678_f1.jpg" "Alto" => 563 "Ancho" => 781 "Tamanyo" => 34582 ] ] "descripcion" => array:1 [ "en" => "Abdominal TC" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10678_108_13125_en_10678_f2.jpg" "Alto" => 563 "Ancho" => 781 "Tamanyo" => 43282 ] ] "descripcion" => array:1 [ "en" => "Fibrocolonoscopy" ] ] 2 => array:8 [ "identificador" => "fig3" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10678_108_13126_en_10678_f3.jpg" "Alto" => 563 "Ancho" => 781 "Tamanyo" => 72333 ] ] "descripcion" => array:1 [ "en" => "Colon biopsy" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ramos-Casals M,\u{A0} Cuadrado MJ, Alba P, Sanna G, et al. Acute Viral Infections in Patients With Systemic Lupus Erythematosus. Description of 23 Cases and Review of the literature. Medicine 2008;87:311-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19011502" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Diep J, Kerr L, Sarebahi S, Tismenetsky M. Opportunistic Infections Mimicking Gastrointestinal Vasculitis in Systemic Lupus Erythematosus. J Clin Rheumatol 2007;13:213-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17762457" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ohashi N, Isozaki T, Shirakawa K, Ikegaya N, et al. Cytomegalovirus Colitis Following Immunosuppressive Therapy for Lupus Peritonitis and Lupus Nephritis. Intern Med 2003;42:362-6." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000001/v0_201502091643/X2013251411051097/v0_201502091644/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000001/v0_201502091643/X2013251411051097/v0_201502091644/en/P1-E515-S2802-A10678-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411051097?idApp=UINPBA000064" ]
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2020 April | 21 | 11 | 32 |
2020 March | 32 | 9 | 41 |
2020 February | 36 | 17 | 53 |
2020 January | 43 | 25 | 68 |
2019 December | 43 | 23 | 66 |
2019 November | 45 | 27 | 72 |
2019 October | 27 | 10 | 37 |
2019 September | 38 | 17 | 55 |
2019 August | 23 | 10 | 33 |
2019 July | 27 | 24 | 51 |
2019 June | 35 | 11 | 46 |
2019 May | 51 | 10 | 61 |
2019 April | 74 | 30 | 104 |
2019 March | 51 | 22 | 73 |
2019 February | 31 | 19 | 50 |
2019 January | 49 | 21 | 70 |
2018 December | 161 | 41 | 202 |
2018 November | 253 | 14 | 267 |
2018 October | 291 | 18 | 309 |
2018 September | 202 | 13 | 215 |
2018 August | 102 | 23 | 125 |
2018 July | 89 | 15 | 104 |
2018 June | 71 | 14 | 85 |
2018 May | 78 | 18 | 96 |
2018 April | 102 | 7 | 109 |
2018 March | 90 | 8 | 98 |
2018 February | 101 | 4 | 105 |
2018 January | 83 | 6 | 89 |
2017 December | 103 | 9 | 112 |
2017 November | 68 | 4 | 72 |
2017 October | 65 | 7 | 72 |
2017 September | 60 | 14 | 74 |
2017 August | 88 | 5 | 93 |
2017 July | 82 | 17 | 99 |
2017 June | 71 | 8 | 79 |
2017 May | 80 | 13 | 93 |
2017 April | 91 | 25 | 116 |
2017 March | 103 | 7 | 110 |
2017 February | 121 | 12 | 133 |
2017 January | 142 | 16 | 158 |
2016 December | 67 | 9 | 76 |
2016 November | 115 | 16 | 131 |
2016 October | 166 | 13 | 179 |
2016 September | 336 | 3 | 339 |
2016 August | 434 | 5 | 439 |
2016 July | 234 | 12 | 246 |
2016 June | 190 | 0 | 190 |
2016 May | 168 | 0 | 168 |
2016 April | 118 | 0 | 118 |
2016 March | 110 | 0 | 110 |
2016 February | 150 | 0 | 150 |
2016 January | 107 | 0 | 107 |
2015 December | 126 | 0 | 126 |
2015 November | 83 | 0 | 83 |
2015 October | 94 | 0 | 94 |
2015 September | 74 | 0 | 74 |
2015 August | 91 | 0 | 91 |
2015 July | 85 | 0 | 85 |
2015 June | 39 | 0 | 39 |
2015 May | 48 | 0 | 48 |
2015 April | 8 | 0 | 8 |