Deciphering Positive Cytomegalovirus IgM Test Results in Immunocompetent Adults Hospitalized with Illness Suspicious for Acute Cytomegalovirus Infection: A Multihospital Study

Shrestha Samuel; Samantha Thomas; Louise Asleson; Anny Nguyen; Jeffery L Meier; Rima El-Herte

doi:10.1093/ofid/ofaf144

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Deciphering Positive Cytomegalovirus IgM Test Results in Immunocompetent Adults Hospitalized with Illness Suspicious for Acute Cytomegalovirus Infection: A Multihospital Study

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Deciphering Positive Cytomegalovirus IgM Test Results in Immunocompetent Adults Hospitalized with Illness Suspicious for Acute Cytomegalovirus Infection: A Multihospital Study

Shrestha Samuel, Samantha Thomas, Louise Asleson, Anny Nguyen, Jeffery L Meier and Rima El-Herte

Open forum infectious diseases, Vol.12(3), ofaf144

02/28/2025

DOI: 10.1093/ofid/ofaf144

PMCID: PMC11935743

PMID: 40134634

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Abstract

Background Previously healthy adults hospitalized with an acute undifferentiated illness who test positive for cytomegalovirus (CMV) immunoglobulin M (IgM) in their serum may have a primary CMV infection, CMV reactivation/reinfection, or a false-positive result. We aimed to understand how clinicians interpret and incorporate positive CMV IgM test results into their diagnostic and management decisions. Methods A retrospective case series study of 13 previously healthy, immunocompetent adults hospitalized with an acute illness in a 12-hospital system from January 1, 2017, to January 1, 2020, who tested positive for CMV IgM within 3 days of hospitalization. Twelve of 13 had CMV IgG. Results Among these 13 adults (median age, 36), elevated liver enzymes (100%), fever (85%), hepatosplenomegaly (54%), and headache (38%) were common. Lymphocytosis was observed in five patients, reactive lymphocytes in three, and one patient died from hemophagocytic lymphohistocytosis. Dual positivity for CMV and EBV IgM was frequent, yet only one patient was tested for both CMV and EBV DNA in blood or for CMV IgG avidity index, which indicated a primary CMV infection. Of the six patients with CMV DNA in blood, four received anti-CMV treatment. Uncertainty regarding CMV’s role in the illness was common, and final assessments varying even among cases with similar clinical presentations and serologic patterns. Conclusions Interpreting positive CMV IgM results in immunocompetent adults hospitalized with acute illness is challenging and ambiguous due to test limitations and confounders. Supplemental CMV IgG avidity testing can help determine whether primary CMV infection caused the illness, thereby refining the diagnosis and potentially influencing clinical decision-making.

hemophagocytic lymphohistiocytosis

CMV diagnosis

CMV disease immunocompetent

CMV IgG avidity

CMV IgM

Details

Title: Subtitle: Deciphering Positive Cytomegalovirus IgM Test Results in Immunocompetent Adults Hospitalized with Illness Suspicious for Acute Cytomegalovirus Infection: A Multihospital Study
Creators: Shrestha Samuel - Creighton University
Samantha Thomas - Creighton University
Louise Asleson - Creighton University
Anny Nguyen - Creighton University
Jeffery L Meier - Iowa City VA Health Care System
Rima El-Herte - CHI Health
Resource Type: Journal article
Publication Details: Open forum infectious diseases, Vol.12(3), ofaf144
DOI: 10.1093/ofid/ofaf144
PMID: 40134634
PMCID: PMC11935743
NLM abbreviation: Open Forum Infect Dis
ISSN: 2328-8957
eISSN: 2328-8957
Publisher: OXFORD UNIV PRESS INC
Grant note: US Department of Veterans Affairs Merit grant: I10BX004434 SeqCure Network
J. L. M. was supported by funding from the US Department of Veterans Affairs Merit grant I10BX004434 and SeqCure Network.
Language: English
Electronic publication date: 03/10/2025
Date published: 02/28/2025
Academic Unit: Infectious Diseases; Epidemiology; Internal Medicine
Record Identifier: 9984800199902771

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