# Successful Reintroduction of Golimumab in a Patient With Rheumatoid Arthritis and Prolonged Epstein-Barr Virus Reactivation With Persistent Anti-Viral Capsid Antigen IgM Antibodies: A Case Report

## TL;DR

A patient with rheumatoid arthritis and prolonged Epstein-Barr virus reactivation successfully resumed golimumab treatment after careful monitoring.

## Contribution

Demonstrates the potential safety of reintroducing anti-TNF-α therapy in RA patients with persistent EBV markers.

## Key findings

- Discontinuation of golimumab and methotrexate resolved EBV reactivation symptoms but left viral markers positive.
- Reintroducing golimumab one year later led to sustained remission of rheumatoid arthritis without EBV complications.
- Close monitoring allowed safe resumption of anti-TNF-α therapy despite ongoing EBV seropositivity.

## Abstract

We report the case of a 63-year-old male patient with rheumatoid arthritis (RA) who experienced Epstein-Barr virus (EBV) reactivation during treatment with methotrexate (MTX) and anti-tumor necrosis factor-alpha (TNF-α) antibody, golimumab (GLM). He presented with marked atypical lymphocytosis, elevated EBV-DNA (4.90 log IU/mL [lower limit of detection: 1.60]), and persistent anti-viral capsid antigen (VCA) IgM antibodies. Discontinuation of MTX and GLM led to rapid symptom resolution, although EBV-DNA and anti-VCA IgM antibodies remained detectable. Two months later, RA relapsed and was managed with prednisolone, bucillamine, and salazosulfapyridine, but disease activity persisted. GLM was reintroduced one year after EBV reactivation, resulting in sustained remission without EBV-related complications, despite continued positivity for viral markers. This case highlights the potential feasibility of resuming anti-TNF-α antibody therapy in patients with RA exhibiting prolonged EBV reactivation and sustained IgM seropositivity under close monitoring.