Immunohistochemically proven cytomegalovirus gastrointestinal diseases in three patients with autoimmune diseases

Cytomegalovirus (CMV) disease is a serious infectious complication in compromised hosts. Therefore, there are several studies on the diagnosis and prophylactic/pre-emptive therapy of CMV diseases in patients with solid organ transplants, bone marrow transplants, hematopoietic stem cell transplants, and HIV diseases. However, in patients with autoimmune disease, there are only few studies on the diagnosis and prediction of CMV diseases. In the present article, we described three autoimmune cases that developed CMV gastrointestinal disease because of therapy-related immunosuppression. Although all three patients had a low-level CMV antigenemia without diarrhea or melena, CMV was detected in the gastrointestinal tract tissue. We concluded that CMV-antigenemia assay has a limited value in the diagnosis and prediction of CMV gastrointestinal disease in patients with autoimmune diseases, and that immunohistochemical confirmation of CMV tissue involvement should be recommended especially when the typical clinical gastrointestinal manifestations are lacking.