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Acid-base changes in haemodialysis.

SIR,-Infection with cytomegalovirus is not uncommon in neonates and young children. Hitherto, the infection in adults has been reported principally as an infectious mononucleosis-like disease with a negative heterophil agglutination test, though exudative pharyngitis and lymph node involvement are usually absent.1-3 We recently saw a 31-year-old Chinese woman in whom the clinical features of disease were compatible with infectious mononucleosis. On admission the patient had a temperature of 100' F. (38' C.); there was faint jaundice and a maculopapular rash over the trunk, back, limbs, and face. Bilateral tender cervical, axillary, and inguinal lymph nodes were present. The liver was enlarged 2 cm. and very tender. Investigations at this stage revealed: Hb 12-9 g./100 ml., W.B.C. 11,000/cu.mm.; atypical monocytes 28%; E.S.R. 21 mm./hour, Paul-Bunnell negative, serum bilirubin 2 mg./100 ml., serum alkaline phosphatase 26 K.A. units, S.G.O.T. 100 S.F. units. Within the next few days the patient's condition worsened. Her temperature rose to 104' F. (40' C.), skin lesions became more severe, the spleen became palpable, but the jaundice disappeared. The haemoglobin fell to 8-6 g./100 ml., neutrophils showed a marked shift to the left, eosinophils 30%, atypical monocytes 10%', reticulocytes 6%, E.S.R. 122 mm./hour, serial Paul-Bunnell negative. As the picture was no longer typical of infectious mononucleosis, an autoimmune or allergic process was considered. Investigations along this line proved negative. Six weeks after admission the patient was clinically asymptomatic with no treatment. The titre of complement-fixing antibody for cytomegalovirus was 1/32 on admission rising to 1/128 four weeks later. This patient is of particular interest in that hepatitis, haemolytic anaemia, and exanthema together with generalized lymphadenopathy were observed. The development of antibodies to cytomegalovirus is good but not incontrovertible evidence that the virus caused her disease. We are indebted to the laboratory, Edgware General Hospital, for the result of diagnostic tests. -We are, etc., A. K. SINHA. M. LOVETT. G. PILLAY. West Hendon Hospital, London N.W.9.