Skip to content
DraconiticResearch
Search Sources API
178,033 studies31 sourcesUpdated 10 min ago
Peer-reviewedCC BY-NC-NDInternal Medicine

An Active Cytomegalovirus Infection and Epstein-Barr Virus Reactivation Complicated by Cytomegalovirus Meningitis and Virus-Associated Hemophagocytic Lymphohistiocytosis during Methotrexate and Upadacitinib Therapy in a Patient with Rheumatoid Arthritis

  • Kazuki Tomiyama
  • Soma Fukami
  • Toshitaka Yukishima
  • Haruka Yonezawa
  • Shin-ichiro Ohmura
Read full textPDFDOICite

Abstract

Methotrexate (MTX) and Janus kinase (JAK) inhibitors are effective treatments for rheumatoid arthritis (RA); however, they may increase the risk of opportunistic infections. We herein report a case of a patient with RA receiving MTX and upadacitinib who developed an active cytomegalovirus (CMV) infection and Epstein-Barr virus (EBV) reactivation, complicated by CMV meningitis and virus-associated hemophagocytic lymphohistiocytosis (HLH). This case highlights that clinicians should consider not only herpes zoster, but also infection or reactivation involving non-VZV herpesviruses, including CMV and EBV, particularly in patients receiving JAK inhibitors in combination with other immunosuppressive agents.

Related

  1. Commentary: Hemophagocytic lymphohistiocytosis induced by immune checkpoint inhibitors: observations and proposed clinical management
    Gauthier Coussement, Maxime Ilzkovitz, Loïc Baudelet +2
    Frontiers in ImmunologyPeer-reviewedCC BY 4.0Full textImmunologyGeneral medicineCrossrefDOAJ
  2. Hemophagocytic Lymphohistiocytosis in a Patient With Alcohol‐Associated Liver Disease: A Case Report Highlighting Diagnostic Challenges
    Adalis Rivera, Hakan R. Toka, Yasser Samra +2
    Clinical case reportsPeer-reviewedCC BY-NC-NDFull textGeneral medicineEurope PMCPMC
  3. Cytomegalovirus Retinitis Mimicking Acute Retinal Necrosis During Upadacitinib Therapy
    Takahiro Matsuoka, Hiroki Kaneko
    CureusPeer-reviewedCC BYFull textGeneral medicineEurope PMC
  4. Hemophagocytic Lymphohistiocytosis as a Clinical Harbinger of Rapid Disease Progression in Multiple Myeloma During Daratumumab-Based Therapy
    Hisaharu Shikata, Masahiko Kaneko, Shoichi Matsukage
    Internal MedicinePeer-reviewedCC BY-NC-NDFull textGeneral medicineJ-STAGE
  5. Late-onset Human Herpesvirus 6 Encephalitis with Secondary Hemophagocytic Lymphohistiocytosis after CAR T-cell Therapy
    Kyoko Masuda, Mana Sota, Aika Kitamura +16
    Internal MedicinePeer-reviewedCC BY-NC-NDFull textEpidemiology & public healthJ-STAGE

Cite

BibTeXRIS
BibTeX
@article{tomiyama2026active,
  title = {{An Active Cytomegalovirus Infection and Epstein-Barr Virus Reactivation Complicated by Cytomegalovirus Meningitis and Virus-Associated Hemophagocytic Lymphohistiocytosis during Methotrexate and Upadacitinib Therapy in a Patient with Rheumatoid Arthritis}},
  author = {Kazuki Tomiyama and Soma Fukami and Toshitaka Yukishima and Haruka Yonezawa and Shin-ichiro Ohmura},
  journal = {Internal Medicine},
  year = {2026},
  month = oct,
  doi = {10.2169/internalmedicine.8164-26},
  url = {https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_8164-26/_article},
  note = {CC BY-NC-ND},
}
RIS
TY  - JOUR
TI  - An Active Cytomegalovirus Infection and Epstein-Barr Virus Reactivation Complicated by Cytomegalovirus Meningitis and Virus-Associated Hemophagocytic Lymphohistiocytosis during Methotrexate and Upadacitinib Therapy in a Patient with Rheumatoid Arthritis
AU  - Kazuki Tomiyama
AU  - Soma Fukami
AU  - Toshitaka Yukishima
AU  - Haruka Yonezawa
AU  - Shin-ichiro Ohmura
PY  - 2026
DA  - 2026/10/08
JO  - Internal Medicine
DO  - 10.2169/internalmedicine.8164-26
UR  - https://www.jstage.jst.go.jp/article/internalmedicine/advpub/0/advpub_8164-26/_article
AB  - Methotrexate (MTX) and Janus kinase (JAK) inhibitors are effective treatments for rheumatoid arthritis (RA); however, they may increase the risk of opportunistic infections. We herein report a case of a patient with RA receiving MTX and upadacitinib who developed an active cytomegalovirus (CMV) infection and Epstein-Barr virus (EBV) reactivation, complicated by CMV meningitis and virus-associated hemophagocytic lymphohistiocytosis (HLH). This case highlights that clinicians should consider not only herpes zoster, but also infection or reactivation involving non-VZV herpesviruses, including CMV and EBV, particularly in patients receiving JAK inhibitors in combination with other immunosuppressive agents.
SN  - 1349-7235
SN  - 0918-2918
ER  -