1537. Reactivation of Latent Cytomegalovirus Infection in Patients with Rheumatologic Disease: A Case–Control Study

Abstract

BackgroundWhile there are emerging reports of cytomegalovirus (CMV) disease in patients with underlying rheumatic conditions, the disease burden, risk factors and clinical sequelae in this population are poorly understood. We sought to describe a cohort of patients with underlying rheumatic disease and CMV infection, then compare those with systemic lupus erythematosus (SLE), the largest subgroup, using case–control methodology to identify risk factors for reactivation and differences in outcomes.MethodsAdults with rheumatic disease and CMV reactivation diagnosed by viral load, viral culture or histopathology from Tufts Medical Center between 2000 and 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.ResultsFourteen patients with rheumatic disease and CMV were included (six SLE, four rheumatoid arthritis, two sarcoid, one psoriatic arthritis, one microscopic polyangiitis). Seven patients had viremia alone and the remainder had tissue-invasive disease (four gastrointestinal, three pulmonary). Thirteen (93%) received corticosteroids within 3 months prior to CMV reactivation. Fever (86%) was the most common symptom. Coinfections were seen in eight (57%), including four with bacteremia. Thirteen (93%) were treated with antiviral therapy for a median of 33 days (range 13–171). Relapse occurred in three patients and four died during hospitalization. Six patients with underlying SLE and CMV reactivation were compared with 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.ConclusionCMV 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.Disclosures 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.