Acute Lupus Pneumonitis with Cytomegalovirus Co-infection in Patients withLupus Nephritis

Abstract

Introduction: Most patients with systemic lupus erythematosus (SLE) show
signs of pulmonary involvement. The clinical manifestations of Lupus
Pneumonitis are the similar to those of acute interstitial pneumonia. The use
of cyclophosphamide in lupus nephritis (LN) is associated with high CMV
titers. Ganciclovir is the main choice of therapy for CMV pneumonia
infection. Case presentation: A 19-year-old female with previous history of
lupus nephritis presented with worsening dyspnea, productive cough with
yellowish sputum and hemoptysis. Following physical, laboratory and
radiological examinations, the patient was diagnosed with acute lupus
pneumonitis, with a differential diagnosis of pneumonia infection. During
treatment in the intensive care unit (ICU), she was put on ventilator and
received routine hemodialysis due to pulmonary edema. She was given
intravenous antibiotics before the culture results came out, but there was
no clinical improvement. Once the culture results returned negative, the
antibiotics were discontinued and IV pulse methylprednisolone was started.
There was significant clinical, radiological, and laboratory improvements.
After discharge, the patient experienced hemoptysis again due to CMV
pneumonia infection and was given ganciclovir therapy with satisfactory
results. Conclusion: In patients with advanced LN and pulmonary
involvement, distinguishing between infection and SLE flares may be
challenging, which can cause dilemma in diagnosis and treatment decisions.
Adequate oxygenation with ventilator, hemodialysis, and administration of
ganciclovir and mycophenolic acid provides significant improvements in
patient care.