Methods: Adults with rheumatic disease and CMV reactivation diagnosed by viral load, viral culture or histopathology from Tufts Medical Center between 2000-2015 were identified. Due to SLE cases comprising 43% of the total, these patients were matched 3:1 with SLE controls based on age, sex and year of admission.
Results: 14 patients with rheumatic disease and CMV were included (6 SLE, 4 rheumatoid arthritis, 2 sarcoid, 1 psoriatic arthritis, 1 microscopic polyangiitis). 7 patients had viremia alone and the remainder had tissue-invasive disease (4 gastrointestinal, 3 pulmonary). 13 (93%) received corticosteroids within 3 months prior to CMV reactivation. Fever (86%) was the most common symptom. Coinfections were seen in 8 (57%), including 4 with bacteremia. 13 (93%) were treated with antiviral therapy for a median of 33 days (range 13-171). Relapse occurred in 3 patients and 4 died during hospitalization.
Six patients with underlying SLE and CMV reactivation were compared to 18 controls. Cases received significantly more corticosteroids during the 8-week period prior to admission (median 36.5 vs 2.5 mg/day, p=0.006), had longer hospitalizations (median 46.5 vs 6.5 days, p=0.006) and more frequent co-infections (67% vs 17%, p=0.04). There were no significant differences in symptoms at presentation.
Conclusion: CMV reactivation occurs in patients with rheumatic disease, and can result in severe clinical sequelae that may be difficult to distinguish from a flare of the underlying disease. Patients with CMV were more likely to have received high doses of corticosteroids, and developed more co-infections during their hospitalization. Clinicians should consider this diagnosis during the evaluation of a febrile illness in the rheumatologic population.
R. Bailey, None
J. Chow, None
D. Snydman, Merck: Board Member , Consulting fee and Grant recipient . Shire: Board Member , Consulting fee . Takeda: Board Member , Consulting fee . Chimerix: Board Member , Consulting fee . Seres Therapeutics: Grant Investigator , Grant recipient . Actelion: Grant Investigator , Grant recipient . Moderna: Board Member , Consulting fee . Summit: Grant Investigator , Grant recipient . Tetraphase: Grant Investigator , Grant recipient .
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