Immune Thrombocytopenic Purpura Secondary to Cytomegalovirus Infection: A Case Report

Abstract

Immune thrombocytopenic purpura (ITP) is defined as an acquired thrombocytopenia with antibodies detected against platelet surface antigens, and it is the most common form of thrombocytopenia in otherwise asymptomatic adults. ITP secondary to an underlying condition is a diagnosis of exclusion that is essential to establish for treatment efficacy. Secondary thrombocytopenia caused by cytomegalovirus (CMV) is common; however, case reports associated with diagnosis in immunocompetent adults are rare, and to the best of our knowledge only 20 publications have been associated with this diagnosis. Our report is based on a clinical presentation of a 37-year-old female complaining of petechiae, heavy menses, shortness of breath, and a platelet count of 1 × 109/L. Treatment with IVIG and steroids failed to improve platelet count. Subsequently, an infectious laboratory workup was performed, detecting CMV infection, and treatment with antiviral agents was initiated, causing platelet count to increase as viral load decreased.

Correlations Between Cytomegalovirus Infection and Cutaneous-Mucosal Manifestations of Immune Thrombocytopenic Purpura

“…The clinical picture consists of symptoms such as: general malaise, myalgia, headache, fever. Clinical syndromes such as pneumonia, encephalitis, retinitis, uveitis, colitis may be associated [10].…”

Coexisting Situs Inversus Totalis and Immune Thrombocytopenic Purpura

“…Immune (idiopathic) thrombocytopenic purpura is an autoimmune disease characterized by the destruction of thrombocytes or suppression of their production as a result of an immune reaction with thrombocyte membrane autoantigens [ 1 ]. Therapy is required when the thrombocyte count falls below 20,000/mm 3 or if there are symptoms such as mucosal or vaginal hemorrhage when the count is in the range 20,000–50,000/mm 3 .…”

“…Chronic immune thrombocytopenic purpura (ITP) is an autoimmune disease characterized by an immune response to thrombocyte membrane antigens. ITP is generally treated with surgery and steroids [ 1 ]. Situs inversus totalis is a rare congenital abnormality in which all of the mediastinal and abdominal organs are transposed to mirror symmetry of the normal anatomy.…”

Cytomegalovirus Has No Impact on Immune Thrombocytopenia Bleeding Scale or Prognostic Outcomes in Egyptian Pediatric Immune Thrombocytopenia

“…6 It is a serious cause of morbidity and mortality among immune compromised patients. 7 Several studies have suggested that infection with CMV might be closely associated with the pathogenesis of immune thrombocytopenia; [8][9][10] however, it has also been reported that there is no obvious correlation between the resolution of thrombocytopenia and CMV clearance. 11 Though the mechanism by which a CMV-induced thrombocytopenia may occur remains unclear, the implication of CMV in the pathogenesis of thrombocytopenia could be explained by several theoretical mechanisms.…”