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Serious complications, whether or not related to CMV reactivation, constitute a highly likely cause of death.22 Elderly patients, with comorbidities, in poor health, in which systemic manifestations are more evident, in whom the causative medication has been perpetuated for a longer time, or in whom specific treatment has been delayed tend to have a worse prognosis and slower recovery.82–85 Systemic autoimmune sequelae can appear months and even years after resolution, such as autoimmune thyroiditis, fulminant type I diabetes, autoimmune hemolytic anemia and alopecia
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Glutamine metabolism sustains immune cell activity by supporting redox homeostasis and fueling the TCA cycle, while one-carbon units derived from serine are critical for the epigenetic regulation (e.g., DNA methylation) required for T cell differentiation [113,114]
