Cytomegalovirus-induced thrombocytopenia in an immunocompetent adult effectively treated with intravenous immunoglobulin: A case report and review

Abstract

The authors report the case of an 80-year-old male patient who presented with colitis and severe thrombocytopenia. The work-up revealed concurrent cytomegalovirus infection. After failure of prednisone, a single infusion of high-dose intravenous immunoglobulin produced a rapid and sustained response. Seventeen cases from the world literature are reviewed. Corticosteroids seem effective in about one third of cases. In those who do not respond, splenectomy is relatively ineffective and more specific anti-CMV treatment with ganciclovir is of unproven efficacy and toxic, in view of the relatively favourable long term outcome the authors recommend intravenous immunoglobulin in cases of severe bleeding or when the platelet level is under 10 x 10(9) l.

CMV-related thrombocytopenia treated with foscarnet: A case series and review of the literature

“…Severe thrombocytopenia as a complication of CMV infection in immune competent adults is uncommon with only a few cases reported in the literature [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The mechanism of CMV-related thrombocytopenia is unclear, resulting in a wide range of treatments used, including corticosteroids [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22], intravenous immune globulin [8,18,[20][21][22], splenectomy [8,[10][11][12]18] and vincristine [8,10], with no clear superiority of one treatment over the others.…”

Severe Steroid-resistant Thrombocytopenia Secondary to Cytomegalovirus Infection in an Immunocompetent Adult

“…Although a few previous cases appeared to have been worsened by treatment with steroids (15), corticosteroids were the main and effective treatment for CMV-related thrombocytopenia (20). Some authors recommend a short trial of corticosteroids as a firstline therapy, with subsequent IVIG in refractory cases with severe bleeding (9,24,25). In the present case, administration of IVIG was very effective, resulting in the immediate return of a normal platelet count along with the improvement of atypical lymphocytosis (Fig.…”

“…In almost all of these cases, corticosteroids were administered as a first-line therapy. However, some patients appeared to show only a partial response or no response, and few reports have provided detailed information concerning the response (9). The present report describes the case of an immunocompetent adult who presented with severe thrombocytopenia secondary to CMV infection that was refractory to steroid therapy.…”

A rare case of autoimmune pancytopenia (AIP) preceded by refractory anemia: possible involvement of cytomegalovirus (CMV) infection in pathogenesis

“…The use of foscarnet, which does not share the myelosuppressive effects of ganciclovir and valganciclovir, seems to be a reasonable first line anti-CMV agent in cases of cytopenia [23]. Splenectomy [21,23,24] and intravenous immunoglobulin [19,22,24,], useful in patients affected by idiopathic thrombocytopenic purpura, are relatively ineffective or refractory for CMV-induced thrombocytopenia. However, it is known that splenectomy regain their efficacy once the primary CMV infection is controlled with anti-CMV agents [23,24].…”

“…Human CMV is a β human herpesvirus and can cause lifethreatening infections in immunocompromised patients. It is known that CMV infection can cause thrombocytopenia in immunocompetent adults as well as children [17][18][19][20][21][22][23][24][25]. In addition, CMV infection is known to trigger an autoimmune process against platelets even though the infection itself is transient and seemingly neither atypical nor severe in nature [19].…”