Background/Purpose: Cytomegalovirus (CMV) infections occur frequently in immunocompromised patients. This disease will be fatal if proper treatment is not done. Therefore, in the treatment of connective tissue disease (CTDs), care should be taken while paying attention to the onset of cytomegalovirus infection. The purpose of this study is to clarify the predictors of CMV infection that developed in patients undergoing immunosuppressive treatment.

Methods: All CTD patients who were diagnosed as a CMV infection from January 2009 to March 2017 at our hospital were retrospectively reviewed. The diagnosis of CMV was made by clinical symptoms, radiological findings, the presence of CMV pp65 antigen in polymorphonuclear leukocyte (C7-HRP) and pathological findings of organ specimen. We compared the sequential changes in laboratory data between one month before diagnosis and at diagnosis. The differences in laboratory data between the survivors and non-survivors were also compared. Statistical analyses were performed using XLSTAT.

Results: A total of 20 patients were diagnosed with CMV infection (12 bone marrow suppression; 4 pneumonia; 2 enteritis; 1 genital ulcer; and 1 retinitis) and enrolled in this study. The mean age was 67.9 years old and 60% of patients was female. The CTDs of patients as follows: dermatomyositis (25%), adult-onset Still’s disease (15%), and microscopic polyangiitis (15%). All patients were positive for CMV pp65 (mean C7-HRP: 287.6 ± 510.0/50,000 WBC), who were treated with a moderate to high dose of glucocorticoids (mean prednisolone dose: 33.4 ± 15.9 mg/day). When compared laboratory data between one month before diagnosis and at diagnosis, reduction of leukocyte cells, lymphocytes, platelet counts and IgG levels were predictive for occurring CMV infection. Among them, lymphopenia was critical for distinguishing between survivors and non-survivors.

Conclusion: The decreased in the leukocyte, lymphocyte, platelet, and IgG levels are important predictive factors for CMV infection in CTDs. Among them, decreased lymphocytes counts is a critical predictive factor for life threatening condition.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/predictive-factors-of-cytomegalovirus-infection-in-patients-with-connective-tissue-diseases-treated-with-immunosuppressive-drugs/