Key result
Long-term immunosuppression in rheumatoid arthritis leads to CMV exudative pericarditis and S. aureus endocarditis.
Why the study?
Differential diagnosis between autoimmune and infectious pericardial involvement is challenging in patients with rheumatoid arthritis receiving long-term immunosuppressive therapy.
Case Report (n=1)
No
This case highlights the critical need to exclude opportunistic infections such as cytomegalovirus when evaluating recurrent exudative pericarditis in rheumatoid arthritis patients receiving long-term immunosuppressive therapy.
Clinicians should consider CMV in immunosuppressed RA patients with pericarditis; case report leaves open prevalence and testing strategies.
We present a clinical case of exudative pericarditis associated with generalized cytomegalovirus infection in a patient with seropositive rheumatoid arthritis receiving long-term immunosuppressive therapy. At the onset of the disease, polyserositis (pericarditis and pleuritis) was regarded as a systemic manifestation of rheumatoid arthritis, which was supported by a favorable response to methotrexate and glucocorticoid therapy. More than one year later, during ongoing immunosuppression, the patient developed severe recurrent serosal involvement with massive exudative pericarditis and pleuritis associated with cytomegalovirus infection. The clinical course was further complicated by infective endocarditis accompanied by Staphylococcus aureus bacteremia. This clinical case demonstrates the challenges of differential diagnosis between autoimmune and infectious pericardial involvement in patients with rheumatoid arthritis and highlights the importance of excluding opportunistic infections in patients receiving long-term immunosuppressive therapy.
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Ananev et al. (2026) conducted a case report in Exudative pericarditis associated with generalized cytomegalovirus infection in seropositive rheumatoid arthritis (n=1). Long-term immunosuppressive therapy (methotrexate and glucocorticoids) and generalized cytomegalovirus infection was evaluated on Massive exudative pericarditis and pleuritis complicated by Staphylococcus aureus infective endocarditis. Long-term immunosuppressive therapy in 1 rheumatoid arthritis patient was complicated after >1 year by CMV-associated massive exudative pericarditis and S. aureus endocarditis.
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