Investigation of Clinical Features and Association between Vascular Endothelial Injury Markers and Cytomegalovirus Infection Associated with Thrombotic Microangiopathy in Patients with Anti-Neutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis: Case-Based Research. Int J Mol Sci 2024 Jan 09;25(2)
Date
01/23/2024Pubmed ID
38255886Pubmed Central ID
PMC10815804DOI
10.3390/ijms25020812Scopus ID
2-s2.0-85183249855 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) can occasionally trigger thrombotic microangiopathy (TMA). Cytomegalovirus (CMV) may be reactivated during intensive immunosuppressive therapy for AAV and cause TMA. Therefore, we aimed to evaluate the clinical features of and the association between vascular endothelial injury markers and TMA due to CMV in patients with AAV. A 61-year-old female was diagnosed with AAV and severe kidney injury. Immunosuppressive therapy gradually improved her symptoms and laboratory findings. However, 2 weeks after induction therapy initiation, she exhibited altered consciousness, a significant decrease in platelet count, and hemolytic anemia, resulting in a TMA diagnosis. Plasma exchange did not improve TMA findings and routine screening test revealed CMV infection. Ganciclovir injection improved the infection and TMA findings. Consequently, we diagnosed her with CMV-induced TMA. Both AAV and CMV may induce severe vascular endothelial injury, potentially leading to TMA development. CMV-induced TMA should be considered when TMA develops during induction therapy against AAV. Moreover, of the three serum markers of vascular injury-serum sulfatides, soluble thrombomodulin, and pentraxin 3-serum sulfatides may be associated with the development of TMA, and a high level of soluble thrombomodulin may be associated with the development of CMV viremia during the clinical course of AAV.
Author List
Nimura T, Aomura D, Harada M, Yamaguchi A, Yamaka K, Nakajima T, Tanaka N, Ehara T, Hashimoto K, Kamijo YAuthor
Kosuke Yamaka Postdoctoral Researcher in the Physiology department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Anti-Neutrophil Cytoplasmic Antibody-Associated VasculitisAntibodies, Antineutrophil Cytoplasmic
Cytomegalovirus
Cytomegalovirus Infections
Female
Humans
Middle Aged
Sulfoglycosphingolipids
Thrombomodulin
Thrombotic Microangiopathies
Vascular System Injuries
