Reactivation of cytomegalovirus infection in a rheumatoid arthritis patient with immunosuppressive therapy in the background


DOI: https://dx.doi.org/10.18565/therapy.2022.3.126-129

Budko A.A., Georginova O.A.

M.V. Lomonosov Moscow State University
Abstract. According to the literature data, the treatment of autoimmune rheumatological diseases with the use of basic anti-inflammatory drugs and genetically engineered biological agents may be accompanied by the reactivation of latent infections, including viral ones. Article presents a clinical case of the curation of a patient with rheumatoid arthritis, in which reactivation of cytomegalovirus (CMV) infection against the background of immunosuppressive therapy was observed.

Literature


1. Насонов Е.Л., Каратеев Д.Е., Балабанова Р.М. Ревматоидный артрит. В кн.: Ревматология. Национальное руководство. Под ред. Е.Л. Насонова, В.А. Насоновой. М.: ГЭОТАР-Медиа. 2008; с. 290–331. [Nasonov E.L., Karateev D.E., Balabanova R.M. Rheumatoid arthritis. In: Rheumatology. National guide. Ed. by E.L. Nasonova, V.A. Nasonova. Moscow: GEOTAR-Media. 2008; pp. 290–331 (In Russ.)]. ISBN: 978-5-9704-0672-4.


2. Bullock J., Rizvi S., Saleh A.M. et al. Rheumatoid arthritis: A brief overview of the treatment. Med Princ Pract. 2018; 27(6): 501–7. https://dx.doi.org/10.1159/000493390.


3. Chopra A., Abdel-Nasser A. Epidemiology of rheumatic musculoskeletal disorders in the developing world. Best Pract Res Clin Rheumatol. 2008; 22(4): 583–604. https://dx.doi.org/10.1016/j.berh.2008.07.001.


4. Фоломеева О.М., Галушко Е.А., Эрдес Ш.Ф. Распространенность ревматических заболеваний в популяциях взрослого населения России и США. Научно-практическая ревматология. 2008; 4: 4–13. [Folomeeva O.M., Galushko E.A., Erdes Sh.F. Prevalence of rheumatic diseases in adult populations of Russian Federation and USA. Nauchno-prakticheskaya revmatologiya = Rheumatology Science and Practice. 2008; 4: 4–13 (In Russ.)]. https://dx.doi.org/10.14412/1995-4484-2008-529.


5. Клинические рекомендации. Ревматоидный артрит (утв. Минздравом России). Ассоциация ревматологов России. 2018. ID: КР 250. Доступ: https://legalacts.ru/doc/klinicheskie-rekomendatsii-revmatoidnyi-artrit-utv-minzdravom-rossii (дата обращения – 02.04.2021). [Clinical guidelines. Rheumatoid arthritis (approved by Ministry of Healthcare of Russia). Association of Rheumatologists of Russia. ID: KP 250. URL: https://legalacts.ru/doc/klinicheskie-rekomendatsii-revmatoidnyi-artrit-utv-minzdravom-rossii (date of access – 02.04.2021).


6. Lin T.C., Yoshida K., Tedeschi S.K. et al. Risk of hepatitis B virus reactivation in patients with inflammatory arthritis receiving disease-modifying antirheumatic drugs: A systematic review and meta-analysis. Arthritis Care Res (Hoboken). 2018; 70(5): 724–31. https://dx.doi.org/10.1002/acr.23346.


7. Sztajnbok F., Boechat N.L., Oliveira S.K. et al. Latent tuberculosis infection in patients with juvenile idiopathic arthritis undergoing methotrexate therapy: A longitudinal study with TST and ELISPOT. Pediatr Rheumatol Online J. 2014; 12: 17. https://dx.doi.org/10.1186/1546-0096-12-17.


8. Grove M.L., Hassell A.B., Hay E.M., Shadforth M.F. Adverse reactions to disease modifying anti-rheumatic drugs in clinical practice. QJM. 2001; 94(6): 309–19. https://dx.doi.org/10.1093/qjmed/94.6.309.


9. Thomas K., Vassilopoulos D. Infections in patients with rheumatoid arthritis in the era of targeted synthetic therapies. Mediterr J Rheumatol. 2020; 31(Suppl 1): 129–36. https://dx.doi.org/10.31138/mjr.31.1.129.


10. Rasha H.B., Reham A.D., Eman M.E. et al. Elevated cytomegalovirus and Epstein–Barr virus burden in rheumatoid arthritis: A true pathogenic role or just a coincidence. The Egyptian Rheumatologist. 2019; 41(4): 255–59. https://dx.doi.org/10.1016/j.ejr.2019.03.003.


11. Febres-Aldana A.J., Febres-Aldana C.A., Dvir K. et al. Reactivation of Epstein–Barr virus presenting as massive splenomegaly after initiation of golimumab treatment. Case Rep Hematol. 2020; 2020: 3641813. https://dx.doi.org/10.1155/2020/3641813.


12. McKeown E., Pope J.E., Leaf S. Epstein–Barr virus (EBV) prevalence and the risk of reactivation in patients with inflammatory arthritis using anti-TNF agents and in those who are biologic naive. Open Rheumatol J. 2009; 3: 30–34. https://dx.doi.org/10.2174/1874312900903010030.


13. Komura T., Ohta H., Nakai R. et al. Cytomegalovirus reactivation induced acute hepatitis and gastric erosions in a patient with rheumatoid arthritis under treatment with an anti-IL‑6 receptor antibody, tocilizumab. Intern Med. 2016; 55(14): 1923–27. https://dx.doi.org/10.2169/internalmedicine.55.5981.


14. Van Duin D., Miranda C., Husni E. Cytomegalovirus viremia, pneumonitis, and tocilizumab therapy. Emerg Infect Dis. 2011; 17(4): 754–56. https://dx.doi.org/10.3201/eid1706.101057.


15. Georg H., Burkhard J. M., Yvonne J. et al. Cytomegalovirus retinitis in a patient treated with anti-tumor necrosis factor alpha antibody therapy for rheumatoid arthritis. Clin Infect Dis. 2004; 39(9): e88–94. https://dx.doi.org/10.1086/425123.


16. Gardine B.J., Haas E.M., Bailey R.C. et al. Reactivation of latent cytomegalovirus infection in patients with rheumatologic disease: a case–control study. Rheumatol Int. 2019; 39(7): 1229–40. https://dx.doi.org/10.1007/s00296-019-04324-6.


17. Государственный реестр лекарственных средств. В 2 т. М.: Медицинский совет. 2009; с. 568. [State register of medicines. In 2 vol. Moscow: Meditsinskiy sovet = Medical Council. 2009; p. 568 (In Russ.)]. ISBN: 978-5-904523-01-5, 978-5-904523-03-9.


18. Miceli-Richard C., Gestermann N., Amiel C. et al. Effect of methotrexate and anti-TNF on Epstein-Barr virus T-cell response and viral load in patients with rheumatoid arthritis or spondylarthropathies. Arthritis Res Ther. 2009; 11(3): R77. https://dx.doi.org/10.1186/ar2708.


About the Autors


Anton A. Budko, resident of the 2nd year of the Department of internal diseases of the Faculty of fundamental medicine, M.V. Lomonosov Moscow State University. Address: 119192, Moscow, 27 build. 10 Lomonosovsky Avenue. ORCID: https://orcid.org/0000-0002-7362-176X
Olga A. Georginova, PhD in Medicine, assistant at the Department of internal medicine of the Faculty of fundamental medicine, M.V. Lomonosov Moscow State University, therapist-rheumatologist at the Department of specialized medical care of the Department of the Medical Research and Educational Center, M.V. Lomonosov Moscow State University. Address: 119192, Moscow, 27 build. 10 Lomonosovsky Avenue. E-mail: olga.georginova@gmail.com. ORCID: https://orcid.org/0000-0002-7542-8189


Similar Articles


Бионика Медиа