Massive exudative pericarditis associated with cytomegalovirus infection in a patient with rheumatoid arthritis

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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