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Objectives:  To investigate whether cytomegalovirus (CMV) infection plays a role in the pathogenesis and prognosis of idiopathic inflammatory myopathy (IIM), particularly in anti-MDA5 antibody-positive (anti-MDA5 + ) dermatomyositis (DM).   Methods:  A prospective cohort of 204 newly diagnosed IIM patients and 50 healthy individuals were enrolled in the study. CMV-IgM and CMV-IgG antibody concentrations and lymphocyte counts were analyzed. Differences in categorical data were compared using Fisher's exact test and the chi-square test. One-year survival rates were analyzed in MDA5 +  DM patients with and without CMV infection.   Results:  In IIM patients, the median CMV-IgM level was significantly higher than in healthy controls (6 U/mL vs. 0 U/mL,  p  < 0.05) as was the median CMV-IgG level (114 U/mL vs. 105 U/mL,  p  < 0.05). The percentage of recent CMV infections in the MDA5 +  DM group was much higher than it was in the MDA5 −  IIM group (19.1% vs. 7.0%,  p  = 0.009). MDA5 +  DM patients with CMV DNA-emia had poorer 1 year survival than the CMV-DNA −  group (33.3% vs. 86.3%,  p  = 0.010). CMV-IgM-positive (CMV-IgM + ) MDA5 +  DM patients had lower CD4 +  T cell counts (245.7 cells/μL vs. 420.5 cells/μL,  p  < 0.05) and CD19 +  B cell counts (97.3 cells/μL vs. 240.6 cells/μL,  p  < 0.05).   Conclusion:  The number of CMV infections was significantly higher in IIM patients, particularly in MDA5 +  DM patients. Lower CD4 +  T cells and CD19 +  B cells were observed in CMV-IgM +  MDA5 +  DM patients. CMV infection may have an important role in the pathogenesis and prognosis of MDA5 +  DM by disrupting immunity.

Association of Cytomegalovirus Infection With Anti-MDA5 Antibody-Positive Dermatomyositis: A Prospective Cohort Study