Fatal cytomegalovirus infection in two patients with systemic lupus erythematosus undergoing intensive immunosuppressive therapy: role for cytomegalovirus vigilance and prophylaxis?

Cytomegalovirus (CMV) infection is an uncommon but potentially fatal opportunistic infection in patients with systemic lupus erythematosus (SLE). We report 2 patients with severe SLE with life-threatening, multisystemic involvement who were treated with intensive immunosuppressive therapy. SLE was successfully controlled, but the patients succumbed to fatal reactivation of CMV disease despite antiviral therapy. Both were seropositive for CMV. We therefore advocate that there should be more active CMV vigilance, and polymerase chain reaction (PCR)-based CMV prophylaxis should be considered in CMV PCR-positive patients with SLE/rheumatic disease undergoing intensive immunosuppressive therapy.