Fatal colitis associated with active systemic lupus erythematosus complicated by cytomegalovirus superinfection

Description

A 47-year-old woman was diagnosed with systemic lupus erythematosus (SLE) at age 27 based on articular involvement (Jaccoud's arthropathy), lymphopaenia, thrombocytopaenia, pleuritis and positive antinuclear/anti-dsDNA antibodies. She was under azathioprine 75 mg and mycophenolate mofetil 3 g daily. Renal involvement (diffuse proliferative glomerulonephritis) was diagnosed 2 months ago. She was admitted with a 2-week history of diarrhoea, abdominal pain and intermittent fever. Physical examination revealed lower abdominal discomfort and mild bilateral leg oedema. Laboratory analysis showed severe hypoalbuminaemia, pancytopaenia, elevated C reactive protein (25.8; n<0.5 mg/dL) and normal coagulation tests. She had active disease Systemic lupus erythematosus disease activity index of 23 (SLEDAI-23), starting prednisolone 1 mg/kg/day and 5-day course of intravenous immunoglobulin 2 g/kg/day; mycophenolate mofetil dose was reduced (2.5 mg/day). Infectious disease screening was negative, including cytomegalovirus (CMV) (IgM–/IgG+, negative serum CMV-DNA). Ileocolonoscopy showed a colorectal congestive/granular mucosa with erosions, friability and subepithelial haemorrhagic suffusions (figure 1A–C). Biopsies revealed normal ileal mucosa and SLE-related...

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