Two cases of dermatomyositis with cytomegalovirus infection

Dermatomyositis is frequently associated with opportunistic infection, which is caused by various organisms including cytomegalovirus, Candida albicans, and Pneumocystis carinii. We describe 2 cases of dermatomyositis with cytomegalovirus infection. Case 1: A 67-year-old Japanese woman had visited us in Octorber 2002 for erythema with myalgia on her trunks. Her condition was diagnosed as dermatomyositis, which was treated with prednisolone at first but did not respond well. In addition, we used cyclophosphamide for her therapy. In February 2003, pneumonia developed, and cytomegalovirus and Aspergillus were detected. Although gancyclovir and γ-globulin were immediately started, her general condition worsened and she died on March 2003. In the autopsy, there were histological changes specific to cytomegalovirus infection in the lung. Case 2: A 72-year-old Japanese woman had visited us in November 2004 for erythema with myalgia distributed on her face and trunk. She was diagnosed as dermatomyositis and treated with prednisolone, to which erythema and myalgia responded well. When the daily prednisolone had been gradually decreased to 35mg, liver dysfunction suddenly developed together with pyrexia. Gancyclovir was administered because of the presence of cytomegalovirusemia. Two weeks after the administration, her general condition improved. Both cases suggested the importance of careful examination and appropriate therapy for managing cytomegalovirus infection during the treatment of dermatomyositis.