Cytomegalovirus DNAemia in patients with anti-melanoma differentiation-associated gene 5 positive dermatomyositis from southern China

Cytomegalovirus (CMV) DNAemia represents a significant complication in patients with anti-melanoma differentiation-associated gene 5 positive dermatomyositis (anti-MDA5-positive DM). Here, we aimed to assess the prevalence and risk factors associated with CMV DNAemia in individuals with anti-MDA5-positive DM. Subsequently, we sought to evaluate the impact of CMV DNAemia on the 6-month mortality among these patients. Furthermore, we investigated the independent predictors of mortality in individuals with CMV DNAemia. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for the occurrence of CMV DNAemia. Kaplan-Meier curves and the Log Rank-test were employed to compare cumulative survival differences across various subgroups. Among the 237 patients diagnosed with anti-MDA5-positive DM, 76 cases were classified into the CMV DNAemia-positive group, while the remaining 161 patients were categorized as the CMV DNAemia-negative group. Our study revealed that CMV DNAemia was associated with prior exposure to methylprednisolone pulse therapy, median to high doses of glucocorticoids, and the use of biological disease-modifying antirheumatic drugs, as well as increased levels of lactate dehydrogenase. However, there was no significant difference in 6-month mortality between the CMV DNAemia-positive and the CMV DNAemia-negative groups. Furthermore, our findings indicated that patients with CMV DNAemia who presented with rapidly progressive interstitial lung disease (RP-ILD), co-infection with other pathogens, and increased CMV loads exhibited higher 6-month mortality rates compared to those with non-RP-ILD, without co-infection, and with decreased CMV loads, respectively. CMV DNAemia is prevalent among patients with anti-MDA5-positive DM. However, it does not appear to significantly impact the 6-month mortality of these patients. CMV DNAemia can be effectively managed by identifying potential risk factors, monitoring viral loads dynamically, and initiating preemptive therapy timely.