Cytomegalovirus Infection as Cause of Severe Thrombocytopenia in a Nonimmunosuppressed Patient

Massive Intracranial Bleeding Requiring Emergency Splenectomy in a Patient with CMV-Associated Thrombocytopenia

“…These include CMV-induced bone marrow suppression due to changes in the accessory cells involved in providing growth factors for maintenance and proliferation/differentiation of stem cells, and production of hematopoietic inhibitory cytokines, such as interferon-Á and TNF-· by CMV-infected leukocytes and stromal cells [10,14]. Another mechanism involves a direct cytopathic effect secondary to infection of bone marrow progenitor cells by CMV [8,11,14]. Finally, the thrombocytopenia may be immune-mediated, similar to other autoantibodies detected following CMV infection [8][9][10]14].…”

“…CMV-associated thrombocytopenia is usually mild with platelet counts above 50!10 9 /liter and major bleeding is characteristically absent. Ten cases of severe CMV-associated thrombocytopenia (!20!10 9 /liter) have been described [1][2][3][5][6][7][8][9][10][11], none with major bleeding (table 1). We report a patient with severe CMVassociated thrombocytopenia (platelet counts of 2!10 9 /liter), refractory to conventional therapy who developed massive intracranial bleeding.…”

Does Cytomegalovirus Infection Cause Immune Thrombocytopenia?

“…I read the case report by Arruda et al [1]in a recent issue of Acta Haematologia . Although the authors’ statement ‘viral infections affecting megakaryocytes or platelets which result in a clinical picture of AITP (autoimmune thrombocytopenic purpura)’ is generally correct, we could not show its relevance to cytomegalovirus infection (CMV) in 19 patients with idiopathic thrombocytopenic purpura (ITP) by determining specific CMV IgM and IgG antibodies [2].…”

“…I would also like to emphasize that the presence of platelet antibodies does not necessarily relate to thrombocytopenia at all times [3, 4]like Coombs positivity and the absence of hemolytic anemia in some cases. We showed that 1–2 mg/kg/day of prednisone was not effective in the treatment of acute ITP; actually it suppressed the platelet response [5], which should be considered in the study by Arruda et al [1]. An oral megadose of methylprednisolone (MDMP; daily 30 mg/kg for 3 days, then 20 mg/kg for 4 days) is effective in acute ITP [6].…”

<i>Candida albicans</i>-Induced Chronic Thrombocytopenic Purpura

“…Studies have shown that treatment of the associated infection often results in substantial improvement or even complete recovery from thrombocytopenia [1,2]. There are many reports linking ITP with infection with tuberculosis [3], human immunodeficiency virus (HIV) [4], hepatitis C virus (HCV) [5], Helicobacter pylori [6] and cytomegalovirus [7]. Herein, we present 2 cases of chronic refractory ITP in association with Candida albicans infection.…”