PMID- 36874321
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20231130
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 2
DP  - 2023 Feb
TI  - Lupus Cardiomyopathy and Nephritis Associated With Adalimumab and Cytomegalovirus 
      Infection in a Patient With Seronegative Rheumatoid Arthritis: A Case of Rhupus 
      Syndrome.
PG  - e34489
LID - 10.7759/cureus.34489 [doi]
LID - e34489
AB  - Tumor necrosis factor-alpha (TNF-alpha) inhibitors are associated with lupus-like 
      disease, known as anti-TNF-alpha-induced lupus (ATIL). Cytomegalovirus (CMV) was 
      reported to exacerbate lupus in the literature. To date, systemic lupus 
      erythematosus (SLE) triggered by adalimumab in the setting of CMV infection has 
      never been described. We present an unusual case of a 38-year-old female with a 
      past medical history of seronegative rheumatoid arthritis (SnRA) who developed 
      SLE associated with the use of adalimumab and CMV infection. She had severe SLE 
      features including lupus nephritis and cardiomyopathy. The medication was 
      discontinued. She was initiated on pulse steroid therapy and discharged with an 
      aggressive regimen for SLE, including prednisone, mycophenolate mofetil, and 
      hydroxychloroquine. She remained on the medications until a year later upon 
      follow-up. ATIL from adalimumab usually manifests only mild symptoms of SLE such 
      as arthralgia, myalgia, and pleurisy. Nephritis is very rare, and cardiomyopathy 
      is unprecedented. Concomitant CMV infection might contribute to disease 
      severity. Patients with SnRA may have an increased risk of developing SLE later 
      when exposed to such medications and infection.
CI  - Copyright (c) 2023, Waitayangkoon et al.
FAU - Waitayangkoon, Palapun
AU  - Waitayangkoon P
AD  - Internal Medicine, MetroWest Medical Center, Tufts University School of Medicine, 
      Framingham, USA.
FAU - Chen, Lucas
AU  - Chen L
AD  - Internal Medicine, MetroWest Medical Center, Tufts University School of Medicine, 
      Framingham, USA.
FAU - Liu, Jessica B
AU  - Liu JB
AD  - Internal Medicine, MetroWest Medical Center, Tufts University School of Medicine, 
      Framingham, USA.
FAU - Weins, Astrid
AU  - Weins A
AD  - Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
FAU - Barbosa, Felipe
AU  - Barbosa F
AD  - Infectious Diseases, MetroWest Medical Center, Tufts University School of 
      Medicine, Framingham, USA.
FAU - Treadwell, Thomas
AU  - Treadwell T
AD  - Infectious Diseases, MetroWest Medical Center, Tufts University School of 
      Medicine, Framingham, USA.
LA  - eng
GR  - T32 HL125232/HL/NHLBI NIH HHS/United States
PT  - Case Reports
DEP - 20230201
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC9982757
OTO - NOTNLM
OT  - adalimumab
OT  - adalimumab (humira)
OT  - cardiac lupus
OT  - cytomegalovirus
OT  - cytomegalovirus-cmv
OT  - drug-induced lupus erythematosus
OT  - lupus nephritis
OT  - sle and lupus nephritis
OT  - sytemic lupus erythematosus
OT  - tnf alpha
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/03/07 06:00
MHDA- 2023/03/07 06:01
PMCR- 2023/02/01
CRDT- 2023/03/06 03:54
PHST- 2023/02/01 00:00 [accepted]
PHST- 2023/03/06 03:54 [entrez]
PHST- 2023/03/07 06:00 [pubmed]
PHST- 2023/03/07 06:01 [medline]
PHST- 2023/02/01 00:00 [pmc-release]
AID - 10.7759/cureus.34489 [doi]
PST - epublish
SO  - Cureus. 2023 Feb 1;15(2):e34489. doi: 10.7759/cureus.34489. eCollection 2023 Feb.