RESUMO
A 31-year-old woman with systemic lupus erythematosus and lupus nephritis was treated with prednisone and immunosuppressants. After her lupus nephritis symptoms worsened, both high-dose steroid and cyclophosphamide pulse therapy were administered. The patient developed an intestinal perforation, and laparoscopic Hartmann's surgery was performed on the sigmoid colon. Serum Cytomegalovirus (CMV) antigen C7HRP was detected, and the patient was diagnosed with CMV colitis and underwent a colon resection. Severe hematochezia continued despite ganciclovir administration, and the patient underwent laparoscopic total colectomy and partial ileostomy. CMV enteritis should be considered in patients treated with prednisone and immunosuppressants and those who have abdominal pain and hematochezia. Immunocompromised patients with intestinal perforation due to CMV enteritis have a poor prognosis. We report a case with along with the results of a literature review.
Assuntos
Colite/complicações , Infecções por Citomegalovirus/complicações , Enterite/complicações , Hospedeiro Imunocomprometido , Perfuração Intestinal/etiologia , Nefrite Lúpica/complicações , Adulto , Antivirais/uso terapêutico , Betametasona/administração & dosagem , Betametasona/efeitos adversos , Colo Sigmoide/cirurgia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/tratamento farmacológico , Enterite/virologia , Feminino , Ganciclovir/uso terapêutico , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Perfuração Intestinal/cirurgia , Nefrite Lúpica/tratamento farmacológico , Nefrite Lúpica/imunologia , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos , Tacrolimo/administração & dosagem , Tacrolimo/efeitos adversosRESUMO
OBJECTIVE: Ankylosing spondylitis (AS) is characterized by chronic inflammation of the axial and peripheral joints and ligamentous attachments. Gut immunity is thought to be involved in AS, because a prominent coexistence of gut and joint inflammation has been observed in patients with AS. Mucosal-associated invariant T (MAIT) cells are preferentially located in the gut lamina propria and produce inflammatory cytokines such as interleukin 17 (IL-17) and tumor necrosis factor-α (TNF-α), which are therapeutic targets for AS. This study aimed to investigate the involvement of MAIT cells in AS. METHODS: The frequency of MAIT cells and their cytokine production were determined in patients with AS and healthy controls (HC). The expression of a MAIT cell activation marker (CD69) was analyzed in patients with AS by using flow cytometry. RESULTS: The frequency of MAIT cells in the peripheral blood was lower in patients with AS compared with HC. The levels of IL-17 produced by MAIT cells after activation were higher in patients with AS than in the HC. CD69 expression on MAIT cells correlated with the Ankylosing Spondylitis Disease Activity Score in patients with AS. CONCLUSION: These results suggest the involvement of MAIT cells in the pathogenesis of AS.