LAUSR

Background Cytomegalovirus (CMV) reactivation is one of serious opportunistic infections for immunosuppressed patients, therefore, identifying patients at risk for CMV reactivation is of importance. However, no prospective study about CMV reactivation in connective tissue disease (CTD) has been reported. Objectives To identify risk factors relevant with CMV reactivation in patients with CTD during remission-induction therapy. Methods Consecutive CTD cases who started immunosuppressive therapy from February until December 2017 were enrolled. Serum CMV-IgG was measured before the induction therapy, and subsequently, CMV pp65 antigen was monitored weekly. Patients were divided into 2 groups according to the presence or absence of CMV reactivation, and risk factors for CMV reactivation were analysed. Results Sixty six cases were enrolled. Mean age was 59.9±17.9 y/o, and female was 68.2%. The underlying diseases were following; anti-neutrophil cytoplasmic antibody-associated vasculitis 18, systemic erythematosus 11, polymyositis/dermatomyositis 9, IgG4-related disease 7, giant cell arteritis 6, and others 15. The initial dose of glucocorticoid (GC) was 50.8±11.5 mg/day (0.92±0.15 mg/kg/day) as prednisolone (PSL) with additional methylprednisolone (mPSL) pulse therapy being conducted in 17 (25.8%). Concomitant immunosuppressive therapies were intravenous cyclophosphamide (IVCY) in 25, mycophenolate mofetil 9, and calcineurin inhibitor 7, tocilizumab 2, infliximab 1, abatacept 1, and rituximab 1. None of 10 CMV-IgG negative patients developed CMV reactivation. Among 56 CMV-IgG positive patients, CMV reactivated in 20 patients (35.7%). Among those, CMV infection occurred in 2 patients (hematopoietic injury and hepatitis). Previous history of GC administration (p=0.032), initial GC dose (p=0.033), mPSL pulse therapy (p=0.018), IVCY (p=0.003), and low lymphocyte count 1 week after treatment initiation (p=0.023) were significantly related with CMV reactivation.Abstract AB1357 – Figure 1 Patient flow of this study. Conclusions While no CMV reactivation occurred in CMV-IgG negative cases, treatment regimen and low lymphocyte count were associated with CMV reactivation in CMV-IgG positive CTD cases. Disclosure of Interest None declared