Clinical and laboratory features of cytomegalovirus reactivation in immunosuppressed patients with rheumatic diseases
Abstract
Purpose: This study aimed to evaluate the clinical and laboratory features of cytomegalovirus (CMV) reactivation in immunosuppressed patients with rheumatic diseases and to compare the characteristics of patients with and without mortality. Materials and Methods: This retrospective cohort study included 30 adult patients with rheumatic diseases who were receiving immunosuppressive therapy and underwent CMV polymerase chain reaction (PCR) testing due to clinical and/or laboratory suspicion between November 2016 and April 2024. Patients with CMV PCR positivity were included in the analysis. Demographic, clinical, and laboratory data were collected. Comparisons of clinical and laboratory parameters were conducted according to antiviral treatment use and survival status. Results: Granulomatosis with polyangiitis (23%) and adult-onset Still’s disease (20%) were the most frequent underlying diagnoses. CMV reactivation predominantly occurred during periods of intensive immunosuppressive therapy. Antiviral treatment with ganciclovir was administered in 70% of patients, who had higher CMV viral loads, lower lymphocyte and albumin levels, and higher C-reactive protein levels compared with untreated patients. The overall mortality rate was 23.3%. In multivariable analysis, CMV-associated pneumonia was the only variable independently associated with mortality. Conclusion: CMV reactivation is a serious complication in immunosuppressed patients with rheumatic diseases and is associated with substantial mortality, particularly in the presence of pulmonary involvement.
Keywords
Cytomegalovirus Infections , Rheumatic Diseases , Immunosuppressive Agents , Virus Reactivation
Kaynakça
- Gandhi MK, Khanna R. Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis. 2004;4:725-38.
- Griffiths P, Baraniak I, Reeves M. The pathogenesis of human cytomegalovirus. J Pathol. 2015;235:288-97.
- Stéphan F, Méharzi D, Ricci S, Fajac A, Clergue F, Bernaudin JF. Evaluation by polymerase chain reaction of cytomegalovirus reactivation in intensive care patients under mechanical ventilation. Intensive Care Med. 1996;22:1244-9.
- Cook CH, Yenchar JK, Kraner TO, Davies EA, Ferguson RM. Occult herpes family viruses may increase mortality in critically ill surgical patients. Am J Surg. 1998;176:357-60.
- Kotton CN, Kumar D, Caliendo AM, Asberg A, Chou S, Danziger-Isakov L et al. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2013;96:333-60.
- Nogalski MT, Collins-McMillen D, Yurochko AD. Overview of human cytomegalovirus pathogenesis. Methods Mol Biol. 2014;1119:15-28.
- Ozaki T, Yamashita H, Kaneko S, Yorifuji H, Takahashi H, Ueda Y et al. Cytomegalovirus disease of the upper gastrointestinal tract in patients with rheumatic diseases: a case series and literature review. Clin Rheumatol. 2013;32:1683-90.
- Takizawa Y, Inokuma S, Tanaka Y, Saito K, Atsumi T, Hirakata M et al. Clinical characteristics of cytomegalovirus infection in rheumatic diseases: multicentre survey in a large patient population. Rheumatology (Oxford). 2008;47:1373-8.
- Mori T, Kameda H, Ogawa H, Iizuka A, Sekiguchi N, Takei H et al. Incidence of cytomegalovirus reactivation in patients with inflammatory connective tissue diseases under immunosuppressive therapy. J Rheumatol. 2004;31:1349-51.
- Ramos-Casals M, Cuadrado MJ, Alba P, Sanna G, Brito-Zerón P, Bertolaccini L et al. Acute viral infections in patients with systemic lupus erythematosus: description of 23 cases and review of the literature. Medicine (Baltimore). 2008;87:311-18.
