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BackgroundVaccination schedules, as well as their effectiveness and contraindications, need to be evaluated regularly, especially in specific situations. Congenital Zika Syndrome (CZS) is a severe condition that results in extensive functional and neurological impairment of fetuses and newborns due to Zika virus tropism for fetal neural progenitor cells. Down Syndrome (DS) is the leading genetic cause of intellectual disability. The immune impairment in DS has already been described, but little is known about the immune response of CZS children. Thus, CZS and DS are specific conditions that can be considered for a reassessment of the available immunizations. Here, we carried out serological analyses of attenuated vaccines-induced antibodies for measles, rubella, and yellow fever viruses in children aged 2–7, grouped into asymptomatic controls, DS children, and CZS children.MethodsPlasma samples were taken, and vaccination records were compiled during clinical follow-up. Enzymatic immunoassays for quantifying anti-measles and anti-rubella IgG were performed to assess the response to the Measles, Mumps, and Rubella (MMR) vaccine. Plaque Reduction Neutralization Test (PRNT) was performed to investigate neutralizing antibodies in response to the Brazilian vaccine strain of yellow fever (YF-17DD).ResultsWe highlight similar levels of anti-measles IgG and neutralizing antibodies for YF-17DD among CZS, DS, and asymptomatic children, although low positivity of measles data was seen in the three groups. In DS children, the 2–4-year-old group had an increased level of anti-measles IgG compared to the older group of children aged five to seven years. Lower anti-rubella IgG levels were observed in CZS and DS children compared to asymptomatic children. For anti-rubella IgG, the good performance of vaccination in asymptomatic children is due to younger ones rather than older ones.ConclusionsThere were no reports of adverse events after the use of the MMR and YF-17DD indicating that CZS and DS could continue to receive these vaccines, but our data draws attention to the necessity of monitoring the vaccination response in CZS and DS children over time and the possible need to adhere to national measles vaccination campaigns. Scientific research needs to continue to help develop appropriate CZS and DS health guidelines.

Introduction: Urinary cytology has been used as a monitoring strategy for kidney transplant patients, live under chronic immunosuppression, as it is a non-invasive and low-cost method. The early detection of infections can prevent possible dysfunctionand graft loss. However, its use has been decreased. Methods: We conducted a prospective study on voided urine samples from 29 consecutive patients undergoing kidney transplantation over a continuous period of 17 months, collected during their first-year post-transplantation. One technician prepared the samples by cytocentrifugation, Papanicolaou staining, and one pathologist analyzed them. Decoy cells (DCs) positive samples were prepared, by other two technicians, for contrast phase analysis, ultrastructural study, and immunofluorescence for SV40 T antigen. Results: We evaluated 252 urine samplesfrom26 patients. Two consecutive samples (0.8%) out of five, from the same patient (3.8%), referring to the fourth- and fifth-week post-transplant, showed low-grade squamous intraepithelial lesions; only rare epithelial cells with atypia of undetermined significance were detected (0.4%) in the sample corresponding to the sixth month post-transplant. The patient’s subsequent gynecological examination and Pap smear revealed no changes. Pseudohyphae and fungus yeasts were found in five samples (2.0%) from four patients (15.4%). Trichosporon sp. was identified in the urine of one of these patients. Decoy cells were detected in 25 samples (9.9 %) from six patients (23.1%). Two patients had sustained DCs shedding; one of them, presenting dirty background smears, developed Polyomavirus-associated nephropathy. Ultrastructural study of DCs showed icosahedral viral particles. Immunofluorescence (SV40 T antigen) was positive in DCs nuclei. Analysis by contrast phase was successful in samples with numerous DCs. Conclusion: Systematic urinary cytology after transplantation helps detect some infection signs. Patients with sustained DCs shedding and dirty background smears deserve special clinical attention. Electron microscopy andimmunofluorescence (SV40 T antigen) are alternative techniques to detect polyomavirus reactivation. The findings suggest that urinary cytology still plays a role in kidney transplantation.

IntroductionThe first peak of COVID-19 in Brazil was between April and May 2020, at a time of the year when outbreaks of other tropical diseases, such as dengue, would be expected. COVID-19 and dengue have similar pathogenesis. In general, both may lead to mild symptoms but may also cause severe and even fatal symptoms, especially in patients with comorbidities and probably in cases of overlapping infections. The general objective of this study was to assess whether, during the 2020 pandemic, there were cases of concomitant infection between SARS-CoV-2 and DENV.MethodsFor this, we evaluated the specificity and sensitivity of commercial serological anti-SARS-CoV-2 kits using plasma samples from patients with dengue and healthy donors recruited before COVID-19. In the case of confirmed cases of COVID-19/dengue, we evaluated the clinical evolution of these coinfected patients, compared with mono-infected patients; and quantified chemokines CCL2 and CXCL8 by ELISA in COVID-19 patients in order to correlate them with COVID-19/dengue severity and cases.Results and DiscussionOur results showed that commercial IgA and IgG anti-SARS-CoV-2 kits presented high sensitivity and specificity. This allowed us to see a low rate of co-detection or coinfection between SARS-CoV-2 and DENV in Rio de Janeiro. Among the 57 COVID-19 patients, anti-DENV IgM was detected in five (8.8%). COVID-19/dengue coinfected patients showed no clinical worsening of COVID-19 and cases in which COVID-19 patients had previous exposure to DENV did not influence the clinical severity of COVID-19. Lastly, CCL2 and CXCL8 appeared to be good markers of COVID-19 severity and did not show increased levels in COVID-19/dengue cases.

Abstract This study aimed to evaluate the hematological and coagulation parameters according to the clinical outcomes of coronavirus disease (COVID-19). We analyzed the hematological and coagulation parameters of hospitalized patients with COVID-19 at admission, and two and three weeks during hospitalization. To assess the performance of these parameters in predicting poor outcomes, receiver operating characteristic (ROC) curves were created. We studied 128 patients with COVID-19 (59.2±17.7 years, 56% male). Non-survivors (n=54, 42%) presented significant alterations in hematological and coagulation parameters at admission, such as increased in white blood cells (WBC), neutrophil, and band cell counts, as well as elevated prothrombin time (PT), activated partial thromboplastin time, and D-dimer levels. During follow-up, the same group presented a gradual increase in D-dimer and PT levels, accompanied by a reduction in PT activity, hemoglobin, and red blood cell count (RBC). ROC curves showed that WBC, neutrophil, and band cell counts presented the best area under the curve (AUC) values with sensitivity and specificity of >70%; however, a logistic regression model combining all the parameters, except for RBC, presented an AUC of 0.89, sensitivity of 84.84%, and specificity of 77.41%. Our study shows that significant alterations in hematological and coagulation tests at admission could be useful predictors of disease severity and mortality in COVID-19.

A infecção pelo ZIKV durante a gestação pode levar ao desenvolvimento de anormalidade congênitas, conhecidas como Síndrome da Zika Congênita (SZC). Níveis elevados de citocinas relacionadas ao perfil Th17, como IL17, IL1β e IL6 foram demonstrados durante a infecção pelo ZIKV. Além disso, sabe-se que, durante a gestação, são detectados níveis elevados de TGFβ, o que poderia criar um ambiente favorável à diferenciação de células TCD4 naive em Th17. Sendo assim, recrutamos uma coorte composta por mulheres infectadas durante a gravidez e crianças expostas ao ZIKV por transmissão vertical e que desenvolveram ou não a SZC. Avaliamos mães infectadas pelo ZIKV durante a gestação (Mães, n = 21) e crianças nascidas (Crianças, n = 17) de mães que relataram rash cutâneo durante a gravidez. Como grupo controle, mulheres infectadas pelo ZIKV, mas fora do período gestacional, foram recrutadas (Mulheres, n = 6). Todos os doadores foram avaliados 2-3 anos após a infecção aguda por ZIKV. O diagnóstico da infecção por ZIKV nas mulheres adultas foi confirmado por qRT-PCR. Por citometria de fluxo, caracterizamos (1) subpopulações de células Th17, utilizando os marcadores CCR6, CXCR3 e CCR4 e o perfil de memória (CD45RA e CCR7); (2) frequência de células TCD4 IL-17A+ e TCD4 IL-17A+IFN-γ+ após estimulação in vitro com peptídeos do ZIKV (ZIKV MP). Além disso, quantificamos as citocinas IL17A, IL6 e TGFβ nos sobrenadantes de cultura após a estimulação in vitro com ZIKV MP por ELISA. Observamos maior frequência de células Th17 em Mães e Crianças e no grupo de Mulheres, as células CCR6+DN foram as mais frequentes. Detectamos níveis basais elevados de IL17A em Mães e Crianças; de IL6 em crianças; e TGFβ nas Mães. Após estimulação com ZIKV MP, foi observada redução na produção de IL17A e TGFβ no grupo de Mães, assim como uma diminuição na frequência de células T CD4 IL17A+ (Th17), especialmente naquelas que deram à luz bebês com SZC. Porém, um aumento nas células T CD4 IL17A+IFNγ+ (Th1Th17) foi detectado neste mesmo grupo e nos dois grupos de crianças, mas não no grupo Mulheres. Assim, sugerimos que ocorreu um priming de células Th1Th17 em Mães que deram à luz bebês com SZC e em Crianças, independente do desfecho seu clínico. De acordo com a literatura, células Th1Th17 são consideradas patogênicas, com tropismo para o sistema nervoso central. Desta forma, nossos dados encorajam uma profunda investigação sobre o possível envolvimento das células Th1Th17 no desenvolvimento da SZC.

Quase 6 milhões de crianças com até 5 anos morreram em 2015 (UNICEF), mais da metade por doenças infecciosas evitáveis pela vacinação. Outras enfermidades ainda não são combatidas por vacinas, como aquelas causadas por arbovírus. A Zika (ZIKV) é em geral uma doença branda, autolimitada, mas, na gravidez, pode levar à um espectro de malformações congênitas aos neonatos. Demonstramos que crianças nascidas de mulheres infectadas por ZIKV na gravidez apresentam baixa detecção de anticorpos neutralizantes (AbNeut) anti-ZIKV. Essas crianças são vacinadas de acordo com o Programa Nacional de Imunização, incluindo as vacinas tríplice viral (TV: Sarampo, Caxumba, Rubéola) e a do vírus Febre amarela (YFV). TV e YFV são vacinas de vírus vivos atenuados, administradas em duas doses até os 4 anos. Neste estudo, propomos avaliar a imunidade dessas crianças aos antígenos vacinais dos vírus sarampo (MeV) e rubéola e, YFV. O estudo consiste na coleta de sangue de 90 crianças de 4-5 anos, dispostas em três grupos: G1, sem alterações clínicas, nascidas de mães com qRT-PCR negativo de ZIKV; G2, assintomáticas nascidas de mães com ZIKV qRT-PCR+ ou com critério clínico-epidemiológico de Zika e; G3, com Síndrome da Zika Congênita nascidas de mães ZIKV qRT-PCR+ ou critério clínico-epidemiológico. A imunogenicidade está sendo avaliada pela dosagem dos anticorpos IgG anti-MeV e anti-rubéola (EuroImmun) e detecção de anticorpos neutralizantes (AbNeut) contra YFV por PRNT50. Até o momento, crianças do G1 (apenas n = 3) tomaram 2,7 ± 1,2 doses da TV há 34±19 meses; G2 (apenas n = 3) tomaram 2,6 ± 0,6 doses da TV há 37 ± 6 meses e, G3 (n = 16) tomaram 2,6 ± 0,8 doses da TV há 32 ± 5 meses. Os títulos de IgG anti-MeV foram de 391±314 UI/mL para G1 (2/3 positivos), 150 ± 106 UI/mL para G2 (todos negativos) e 3428 ± 10463 UI/mL para G3 (10/16 positivos). Os títulos de IgG anti-rubéola foram de 55 ± 38 UI/mL para G1 (todos positivos), 23 ± 18 UI/mL para G2 (2/3 positivos) e 35 ± 43 UI/mL para G3 (13/16 positivos). Para a vacina YFV, as G1 tomaram 1,3 ± 0,6 doses há 34 ± 24 meses; G2 tomaram duas doses há 9 ± 3 meses e G3 tomaram 1,3 ± 0,5 doses há 28 ± 18 meses. Os títulos de PRNT50 foram ≥ 320 para G1, de 160 a ≥ 320 para G2 e de 40 a ≥ 320 para G3. Todas as crianças apresentaram títulos de AbNeut anti-YFV. Parece haver diferença na imunogenicidade à TV em relação aos três grupos e imunogenicidade efetiva a vacina YFV em todas as crianças, que serão confirmados aumentando a disponibilidade das amostras.

Paralelo à pandemia de COVID-19, Brasil continuou a enfrentar doenças tropicais como a Dengue. Mas, segundo os Boletins Epidemiológicos, os casos de Dengue no Brasil em 2020 foram subnotificados. O objetivo deste estudo é identificar a frequência de coinfecções por SARS-CoV-2 e DENV e avaliar a gravidade das coinfecções em relação às monoinfecções. Amostras de plasma de 143 pacientes COVID-19 de 2020, 15 doadores saudáveis e 15 pacientes com infecção por DENV de 2013 foram avaliados. Ensaios imunoenzimáticos utilizando testes comerciais foram realizados: Anti-SARS-CoV-2 IgA e IgG (Euroimmun), proteína NS1 do DENV (Platelia), anti-DENV IgM e IgG (Euroimmun). Dentre os doadores saudáveis foi detectado 75% de IgG anti-DENV; dentre os COVID-19, 75,9% IgA anti SARS-CoV-2, 66,7% IgG anti SARS-CoV-2, 80% IgG anti-DENV e por fim, IgM anti-DENV em 6 (4%) casos; dentre os casos confirmados de Dengue, IgA anti SARS-CoV-2 foi detectado em 1 caso (8,3%), IgG anti-SARS-CoV-2 em nenhum caso, NS1 de DENV em 41,7% e IgM anti-DENV em 33,3%. De acordo com o desfecho clínico, a presença ou não de sinais/sintomas no momento da coleta da amostras, os pacients COVID-19 foram reagrupados em brandos/moderados, graves, óbitos e aqueles já recuperados dos sinais/sintomas. Os 6 casos de COVID-19/Dengue também foram avaliados separadamente. Observamos que idosos são maioria em COVID-19 graves e óbitos; mulheres são maioria dos COVID-19 recuperados; tosse é mais frequente em COVID-19; cefaléia, mialgia/artralgia e vômito são mais frequentes na Dengue; pacientes COVID-19/Dengue foram aqueles com alterações vasculares. As DO IgA anti-SARS-CoV-2 foram mais elevadas nos COVID-19 graves, óbitos e COVID-19/Dengue comparados aos doadores saudáveis e pacientes Dengue; as DO IgG anti-SARS-CoV-2 foram mais elevadas nos COVID-19 comparados aos doadores saudáveis e pacientes Dengue; as DO IgA e IgG anti SARS-CoV-2 foram maiores nos COVID-19 óbitos comparado aos recuperados; COVID-19 recuperados ainda mantém níveis de detecção de IgA e IgG anti-SARS-CoV-2 detectáveis. Há diferenças clínicas, demográficas e de detecção de anticorpos anti-SARS-CoV-2 entre pacientes COVID-19 de acordo com o desfecho clínico e dias da doença. Até o momento, 6% de casos de COVID-19 com sugestiva infecção recente por DENV foram identificados. Os casos de coinfecção SARS-CoV-2/DENV estão sendo confirmados por RT-PCR DENV e esperamos a partir desses resultados, tirar mais conclusões.

Chikungunya virus (CHIKV) vertical transmission occurs due to maternal viremia in the prepartum. Clinical presentation in neonates can be varied; however, the consequences of intrauterine exposure on the immune response are unclear. Thus, we aimed to analyze inflammatory alterations in children exposed to maternal CHIKV infection. This is a cross-sectional study that included children exposed to maternal CHIKV infection (confirmed by RT-qPCR and/or IgM). Circulant immune mediators were analyzed by a multiplex assay. RESULTS: We included 33 children, with a mean age of 3 ± 2.9 months-old, and 19 (57.6%) were male. Only one child presented neurological alterations. CHIKV-exposed infants showed elevated levels of MIP-1α, MIP-1β, and CCL-2 (p < 0.05). Pro-inflammatory cytokines such as TNFα, IL-6, and IL-7 (p < 0.0001) were also increased. In addition, lower levels of PDGF-BB and GM-CSF were observed in the same group (p < 0.0001). Principal component (PC) analysis highlighted a distinction in the inflammatory profile between groups, where PC explained 56.6% of the alterations. Our findings suggest that maternal exposure to CHIKV can affect the circulating levels of pro-inflammatory cytokines during the infants’ first year of life. The long-term clinical consequences of these findings should be investigated.

Background: Zika virus (ZIKV) infection causes for mild and self-limiting disease in healthy adults. In newborns, it can occasionally lead to a spectrum of malformations, the congenital Zika syndrome (CZS). Thus, little is known if mothers and babies with a history of ZIKV infection were able to develop long-lasting T-cell immunity. To these issues, we measure the prevalence of ZIKV T-cell immunity in a cohort of mothers infected to the ZIKV during pregnancy in the 2016–2017 Zika outbreak, who gave birth to infants affected by neurological complications or asymptomatic ones.Results: Twenty-one mothers and 18 children were tested for IFN-γ ELISpot and T-cell responses for flow cytometry assays in response to CD4 ZIKV and CD8 ZIKV megapools (CD4 ZIKV MP and CD8 ZIKV MP). IFN-γ ELISpot responses to ZIKV MPs showed an increased CD4 and CD8 T-cell responses in mothers compared to children. The degranulation activity and IFN-γ-producing CD4 T cells were detected in most mothers, and children, while in CD8 T-cells, low responses were detected in these study groups. The total Temra T cell subset is enriched for IFN-γ+ CD4 T cells after stimulation of CD4 ZIKV MP.Conclusion: Donors with a history of ZIKV infection demonstrated long-term CD4 T cell immunity to ZIKV CD4 MP. However, the same was not observed in CD8 T cells with the ZIKV CD8 MP. One possibility is that the cytotoxic and pro-inflammatory activities of CD8 T cells are markedly demonstrated in the early stages of infection, but less detected in the disease resolution phase, when the virus has already been eliminated. The responses of mothers' T cells to ZIKV MPs do not appear to be related to their children's clinical outcome. There was also no marked difference in the T cell responses to ZIKV MP between children affected or not with CZS. These data still need to be investigated, including the evaluation of the response of CD8 T cells to other ZIKV peptides.

In 2015, ZIKV infection attracted international attention during an epidemic in the Americas, when neurological disorders were reported in infants who had their mothers exposed to ZIKV during pregnancy. World Health Organization (WHO) epidemiological data show that 5 to 15% of neonates exposed to ZIKV in the uterus have complications included in abnormalities related to Congenital Zika Syndrome (CZS). The risk of complications after birth is not well documented, however, clinical evidence shows that 6% of infants exposed to ZIKV during pregnancy have complications present at birth, and this rate rises to 14% when medical monitoring is performed in all exposed infants, regardless of birth condition. Thus, the evaluation and monitoring of all exposed infants are of foremost importance as the development of late complications has been increasingly supported by clinical evidence. The identification of changes in protein profile of infants exposed to ZIKV without CZS could provide valuable findings to better understand molecular changes in this cohort. Here, we use a shotgun-proteomics approach to investigate alterations in the serum of infants without CZS symptoms but exposed to intrauterine ZIKV (ZIKV) compared to unexposed controls (CTRL). A complex pattern of differentially expressed proteins was identified, highlighting the dysregulation of proteins involved in axon orientation, visual phototransduction, and global protease activity in children exposed to ZIKV without CZS. These data support the importance of monitoring children exposed to ZIKV during gestation and without early CZS symptoms. Our study is the first to assess molecular evidence of possible late disorders in children victims of the ZIKV outbreak in the Americas. We emphasize the importance of medical monitoring of symptomatic and asymptomatic children, as apparently unexplained late neurological and eye disorders may be due to intrauterine ZIKV exposure.

High levels of T helper 17 cell (Th17)-related cytokines have been shown in acute Zika virus (ZIKV) infection. We hypothesized that the high levels of Th17-related cytokines, associated with a regulatory environment during pregnancy, create a favorable milieu for the differentiation of CD4+Th17 cells. We present data from a cross-sectional study on mothers who confirmed ZIKV infection by qRT-PCR and their children. We also recruited non-pregnant women infected with ZIKV in the same period. ZIKV infection occurred between 2015 and 2017. We collected samples for this study between 2018 and 2019, years after the initial infection. We highlight that, after in vitro stimulation with ZIKV CD4 megapool (ZIKV MP), we found a lower frequency of IL-17-producing CD4+ T cells (Th17), especially in the mothers, confirmed by the decrease in IL-17 production in the supernatant. However, a higher frequency of CD4+ IL-17+ IFN-γ+ T cells (Th1Th17) responding to the ZIKV MP was observed in the cells of the mothers and children but not in those of the non-pregnant women. Our data indicate that the priming of CD4 T cells of the Th1Th17 phenotype occurred preferentially in the mothers who gave birth to children with CZS and in the children.

Abstract Background BK polyomavirus-associated nephropathy is an important cause of post-transplantation renal failure. We present two cases of BK polyomavirus-associated nephropathy who were submitted to contrasting strategies of clinical follow-up to BK polyomavirus reactivation, but progressed to a similar final outcome. Case presentation Case 1 is a 37-year-old white man whose graft had never presented a good glomerular filtration rate function, with episodes of tacrolimus nephrotoxicity, and no urinary monitoring for BK polyomavirus; stage B BK polyomavirus-associated nephropathy was diagnosed by biopsy at 14 months post-transplant. Despite clinical treatment (dosage decrease and immunosuppressive drug change), he progressed to stage C BK polyomavirus-associated nephropathy and loss of graft function 30 months post-transplant. Case 2 is a 49-year-old mulatto man in his second renal transplantation who was submitted to cytological urinary monitoring for BK polyomavirus; he presented early, persistent, and massive urinary decoy cell shedding and concomitant tacrolimus nephrotoxicity. Even with decreasing immunosuppression, he developed BK polyomavirus-associated nephropathy 1-year post-transplant. Loss of graft function occurred 15 months post-transplant. Conclusions Cytological urinary monitoring was an efficient strategy for monitoring BK virus reactivation. Decoy cell shedding may be related to BK polyomavirus-associated nephropathy when extensive and persistent. The presence of associated tacrolimus nephrotoxicity may be a confounding factor for the clinical diagnosis of BK polyomavirus-associated nephropathy.

Introduction: Human cytomegalovirus is a major cause of morbidity in kidney transplant patients. Objectives: We aimed to study viral replication and serological response in the first months post kidney transplant in patients undergoing universal prophylaxis or preemptive therapy and correlate the findings with the clinical course of Human cytomegalovirus infection. Patients and methods: Independent from the clinical strategy adopted for managing Human cytomegalovirus infection, prophylaxis versus preemptive therapy, the pp65 antigenemia assay and serological response were assessed on the day of transplantation, and then weekly during the first three months of post-transplant. Results: From the 32 transplant recipients, 16 were positive for pp65 antigenemia, with a similar incidence rate in each group. There were no positive results in the first three weeks of monitoring; the positivity rate peaked at week eight. There was a trend for a higher and earlier frequency of positivity in the universal prophylaxis group in which the course of the Human cytomegalovirus infection was also more severe. Despite the differences in clinical picture and in the initial immunosuppressant schedule, the serological response was similar in both groups. Conclusion: Routine monitoring during the first three post-transplant months has a positive impact on the early detection of Human cytomegalovirus viral replication allowing for timely treatment in order to reduce morbidity of the disease. The strategy of universal therapy employing intravenous ganciclovir was associated to a worse clinical course of the Human cytomegalovirus infection suggesting that the use of >10 cells/2 × 105 leukocytes as a cut-off in this setting may be inappropriate. Keywords: Cytomegalovirus, pp65 antigenemia, Kidney transplant, Universal prophylaxis, Preemptive therapy

Abstract Hemophagocytic lymphohistiocytosis (HLH) is an uncommon and life-threating condition characterized by major immune activation and massive cytokine production by mononuclear inflammatory cells, due to defects in cytotoxic lymphocyte function. It is even more unusual in renal transplant recipients, in which it is often associated with uncontrolled infection. The mortality is high in HLH and differential diagnosis with sepsis is a challenge. The approach and management depend on the underlying trigger and comorbidities. We report a case of a 50-year-old renal transplant female admitted with fever and malaise 3 months post-transplant and presenting anemia, fever, hypertriglyceridemia, high levels of serum ferritin, and positive CMV antigenemia. Urine was positive for decoy cells and BKV-DNA. Graft biopsy showed CMV nephritis. Both blood and urine cultures where positive for E. coli. Hemophagocytosis was confirmed by bone marrow aspiration. Immunosuppression was reduced, and the patient received high-dose intravenous immunoglobulin and dexamethasone, with complete response after 3 weeks. We highlight the importance of early diagnosis and proper management of a rare and serious condition in a renal transplant patient, which can allow a favorable clinical course and improve survival rate.

ABSTRACT Introduction: In contrast to organ transplantation, few studies correlate the monitoring of pp65 antigenemia with a diagnosis of cytomegalovirus (CMV) in patients with systemic lupus erythematosus (SLE). Objective: To highlight the importance of CMV outside transplantation, we monitored pp65 antigenemia in a series of SLE patients. Methods: From March 2015 to March 2016, SLE patients presenting kidney involvement, fever, and an unclear infection at hospital admission were monitored through pp65 antigenemia. The pp65 antigenemia assay, revealed by immunofluorescence, was correlated with clinical and laboratory findings. Results: We included 19 patients with a suspected unclear infection. A positivity for pp65 antigenemia was found in seven patients (36.8%). The mean age was 33.5 ± 11.2 years, 16 (84%) were females, and 16 (84%) were black. Lymphopenia, anemia, and higher scores of SLEDAI were significantly more common in pp65-positive patients. Five patients received antiviral therapy with ganciclovir. Although receiving specific CMV treatment, one patient died because of suspected CMV disease. Conclusions: Pp65 antigenemia might be relevant in SLE patients, and studies with a greater number of patients are needed in order to establish sensitivity and specificity of pp65 antigenemia in different clinical contexts of SLE patients.