CMV Infection: A Clinical Challenge in Biological Therapy? The Case of Asymptomatic Patients with Persistent Positive Immunoglobulin M Anti-CMV Treated with Secukinumab

Alessio Gambardella,1 Gaetano Licata,1 Giulia Calabrese,1 Alina De Rosa,1 Francesca Pagliuca,2 Roberto Alfano,3 Giuseppe Argenziano1 1Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy; 2Division of Pathology, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy; 3Department of Anesthesiology, Surgery and Emergency, University of Campania Luigi Vanvitelli, Naples, ItalyCorrespondence: Gaetano LicataDepartment of Dermatology, University of Campania “Luigi Vanvitelli”, Via Sergio Pansini, 5, Napoli 80131, ItalyTel +39 081 5666828Fax +39 081 546 87 59Email gaetano.licata89@gmail.comAbstract: The use of biological therapy is now common practice in the treatment of immune-mediated inflammatory diseases (IMID). Currently, there are no guidelines related to the management of cytomegalovirus (CMV) infections or reactivation during therapy with biological agents. Furthermore, there is a lack of guidance on the management of asymptomatic patients with persistent positive immunoglobulin (Ig)M anti-CMV after an extended period and who have to undergo therapy with biological agents. We report the case of a patient in this situation for whom treatment with biological drugs for psoriasis was indicated. A good clinical response was obtained with secukinumab and maintained during 6 months of follow-up. No infectious disease or reactivation of CMV infection occurred. We suggest some possible guidelines for the management of such cases.Keywords: immune-mediated inflammatory diseases, biological therapy, anti-TNF-α therapy, cytomegalovirus, psoriasis, case report