Do not overlook CMV in children with SLE

Persistent fever despite prednisone treatment accompanied by anemia and other serious signs may signal cytomegalovirus (CMV) infection in children who have been diagnosed with pediatric systemic lupus erythematosus (pSLE), a Canadian study suggests.

To determine the prevalence of CMV infection at pSLE diagnosis and identify the risk factors for infection, researchers from the Hospital for Sick Children in Toronto reviewed a database of 670 pSLE patients seen over 20 years. They found 7 children (6 girls, mean age 13 years), or 1.04%, who had a CMV infection at the time their pSLE was diagnosed and reviewed the clinical manifestations, laboratory findings, virology studies, and treatments.

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The predominant characteristics of the children with CMV were non-Caucasian ethnicity compared with the pSLE group as a whole, persistent fever on prednisone (7 patients), and nephrotic syndrome (4 patients). Laboratory tests showed that all 7 children with CMV had anemia; 5 had lymphopenia; 4 had elevated liver enzymes; 6 had anti-dsDNA antibodies; and 5 had anti-RNP antibodies (both associated with SLE). Six of the 7 infected children recovered (1 without treatment), and 1 died of disseminated CMV despite treatment.

All 7 infected patients were non-Caucasian, had persistent fever despite prednisone, and had anemia, the researchers note, suggesting that these characteristics may provide clues to CMV infection in pSLE patients. The researchers propose that all patients newly diagnosed with pSLE undergo routine testing for CMV immunity.

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