CMV infection during treatment with azathioprine in a patient with neuromyelitis optica: case report

*Correspondence: [e-mail].

Abstract

Case Presentation: GBS, 6 years old, male, diagnosed 3 years ago with Optic Neuromyelitis, using azathioprine 3,3mg/kg/day and weaned off corticosteroid therapy 12 days before the onset of fever 10 days before admission. The patient evolved with leukopenia with neutropenia, elevated liver enzymes and daily fever spikes for at least 27 days. Investigation started regarding fever of unknown origin and positive serology for CMV IgM with urinary PCR > 8000 copies. The patient remained clinically and hemodynamically stable, with progressive improvement of symptoms after using ganciclovir for 21 days.

Discussion: Cytomegalovirus (CMV) is a highly prevalent DNA virus and has a peculiar ability to infect and remain integrated into the DNA of host cells, remaining in the form of latent infection. The virus can also cause disease, which normally occurs in immunocompromised patients, promoting increased morbidity and mortality in these patients. Spectrum Neuromyelitis Optica (ENMO) is a severe inflammatory and demyelinating condition of the central nervous system, frequently affecting the optic nerves and spinal cord. The treatment of the disease consists of immunosuppression of the patient in order to prevent new outbreaks.

Final Comments: The importance of maintaining control and surveillance of patients using immunosuppressants is of paramount importance both in the worsening of the baseline condition and opportunistic diseases.

Publication History

Article published online:
12 May 2025