Immunosuppression and infectious complications: A hemorrhagic dilemma

Introduction: Patients treated with immunosuppressive agents for autoimmune diseases are a unique patient population. Simultaneous management of an underlying autoimmune disease and of an opportunistic infection can present a therapeutic dilemma. Case Report: A 68-year-old female presented with signs and symptoms of vasculitis involving the gastrointestinal tract. After initiation of immunosuppressive treatment, she developed an infectious complication that led to intractable gastrointestinal bleeding. Conclusion: Current recommendations addressing the management of cytomegalovirus infection in the context of a severe vasculitis are lacking, and our approach to this case may benefit physicians dealing with this clinical dilemma in the future. (This page in not part of the published article.) International Journal of Case Reports and Images, Vol. 8 No. 8, August 2017. ISSN – [0976-3198] Int J Case Rep Images 2017;8(8):541–544. www.ijcasereportsandimages.com Malhamé et al. 541 CASE REPORT PEER REVIEWED | OPEN ACCESS Immunosuppression and infectious complications: A hemorrhagic dilemma Isabelle Malhamé, Amanda Farag, Zhao Gao, Alan Barkun

[1]  Shinji Sato,et al.  A Case of Polyarteritis Nodosa Associated with Cytomegalovirus Infection , 2014, Case reports in rheumatology.

[2]  L. Mouthon,et al.  Clinical features and outcomes in 348 patients with polyarteritis nodosa: a systematic retrospective study of patients diagnosed between 1963 and 2005 and entered into the French Vasculitis Study Group Database. , 2010, Arthritis and rheumatism.

[3]  K. Saito,et al.  Clinical characteristics of cytomegalovirus infection in rheumatic diseases: multicentre survey in a large patient population. , 2008, Rheumatology.

[4]  L. Guillevin,et al.  Vasculitides secondary to infections. , 2006, Clinical and experimental rheumatology.

[5]  L. Guillevin,et al.  Presentation and Outcome of Gastrointestinal Involvement in Systemic Necrotizing Vasculitides: Analysis of 62 Patients With Polyarteritis Nodosa, Microscopic Polyangiitis, Wegener Granulomatosis, Churg-Strauss Syndrome, or Rheumatoid Arthritis-Associated Vasculitis , 2005, Medicine.

[6]  L. Mouthon,et al.  Treatment of polyarteritis nodosa and microscopic polyangiitis with poor prognosis factors: a prospective trial comparing glucocorticoids and six or twelve cyclophosphamide pulses in sixty-five patients. , 2003, Arthritis and rheumatism.

[7]  S. Kotterba,et al.  Cytomegalovirus infection in systemic necrotizing vasculitis: causative agent or opportunistic infection? , 2000, Rheumatology International.

[8]  M. Doherty,et al.  Polyarteritis nodosa associated with acute cytomegalovirus infection. , 1981, Annals of the rheumatic diseases.