Pulse corticosteroids in treatment of rheumatic disease concomitant with cytomegalovirus infection

AimTo investigate the impact of corticosteroids on the outcome of antiviral therapy in rheumatic patients with cytomegalovirus (CMV)-emia. MethodSixty-two patients with rheumatic disease complicated by CMV infection from 2011 to 2014 were retrospectively analyzed. ResultsFifty-five of 62 patients were diagnosed with CMV-DNAemia. Most patients (43/55, 78.2%) achieved viral clearance within 5weeks. It was shown that, while undergoing active antiviral therapy, there was no significant difference in the CMV-DNAemia clearance rate between the pulse methylprednisolone (MPSL) therapy group and non-pulse group (8/9, 88.9% vs 30/36, 83.3%; OR=1.600, 95% CI 0.168-15.273, P>0.05) at the end of the 5-week follow-up. However, pulse MPSL might slightly prolong duration of CMV-DNAemia than non-pulse MPSL patients (20.7819.18days vs 14.33 +/- 9.01days, P=0.1430), especially in the high baseline titer group (33.7 +/- 29.1days in pulse MPSL group vs 18.3 +/- 13.1days in non-pulse group, P=0.457). But in the low baseline titer group, CMVemia duration in the pulse MPSL group (14.3 +/- 10.0days) was about the same as that in the non-pulse MPSL group (13.4 +/- 7.8days). ConclusionWith effective antiviral therapy, pulse MPSL is acceptable in rheumatic disease patients with CMV-DNAemia, without significant impact on final clearance of virus. However, duration of CMV-DNAemia may be prolonged, especially in patients with high CMV-DNA titer at baseline.