Background/Purpose:

 Cytomegalovirus (CMV) infection is one of the most common opportunistic infections in rheumatic diseases. A definite diagnosis of CMV infection usually requires histopathological confirmation, but performing biopsy is usually difficult in patients with poor general condition. The CMV antigenemia test, which detects the virus-specific protein PP65 antigen in polymorphonuclear leukocyte, is widely used to examine immunocompromised patients with rheumatic diseases and becomes positive (CMV reactivation) regardless of the symptoms. Anti-CMV agents should not be exclusively and needlessly used for asymptomatic patients with CMV reactivation to avoid side effects and social burden due to high medication cost. The aim of this study was to determine the difference in the clinical characteristics between patients with symptomatic and asymptomatic reactivation in rheumatic diseases.

Methods:

We retrospectively examined patients with CMV infection at our department, from January 2008 to December 2016. Patients positive for CMV reactivation were divided into two groups based on the symptoms they experienced, namely, CMV disease (with any symptoms) and asymptomatic CMV reactivation (without symptoms). The CMV antigenemia assay was used to assess the difference in the clinical characteristics between the two groups and their transitions 4 weeks prior to, and during, the first positive diagnosis.

Results:

In 80 patients with CMV reactivation, 31.2% were men and the mean age was 61.0}15.7 years. In the univariate analysis, patients with CMV disease were mostly men, with oral candidiasis, hypoalbuminemia, low lymphocyte count, and high titer CMV antigenemia count. In the multivariate analysis, the odds ratios (ORs) are 8.82 (95% confidence interval (CI) 1.64–47.30, P value=0.01), 0.81 (95% CI 0.69–0.95, P value<0.01), and 1.26 (95% CI 1.05–1.50, P value=0.01) for oral candidiasis, serum albumin, and CMV antigenemia count, respectively (Table 1). Moreover, the transitionfs ORs 4 weeks prior to the first positive diagnosis using the CMV antigenemia are 1.96 (95% CI 1.09–3.54, P=0.025) and 2.02 (95% CI 1.07–3.8 P=0.03) for lymphocyte count and serum albumin, respectively (Table 2).

Conclusion:

Patients with CMV reactivation, who have a gradually decreasing serum albumin and lymphocyte count 4 weeks prior to the first positive diagnosis and who presented with hypoalbuminemia, oral candidiasis, and high CMV antigenemia count during the first positive diagnosis, are highly at risk for CMV disease in rheumatic diseases.