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

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.