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

Sugioka, Takashi; Kubota, Yasushi; Wakayama, Kazuo; Kimura, Shinya

doi:10.2169/internalmedicine.51.7193

Cited by 10 publications

(3 citation statements)

References 28 publications

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“…After excluding reports on immunocompromised patients or other CMV‐related disorders (e.g., thrombotic microangiopathies, haemophagocytic syndrome, etc. ), 25 cases described in 23 articles 5,9–30 that had been published between 1973 and 2016 remained. Five previously unreported cases from three Israeli medical centres were identified in the database searches.…”

Section: Resultsmentioning

confidence: 99%

Characteristics and outcomes of adults with cytomegalovirus‐associated thrombocytopenia: a case series and literature review

et al. 2020

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Cytomegalovirus (CMV) is a ubiquitous virus that infects people worldwide. CMV is known to trigger thrombocytopenia, but this association is probably underdiagnosed since CMV infection in healthy adults is usually either asymptomatic or causes only mild symptoms. A systematic literature review was carried out and yielded 23 publications that reported 25 patients. All haematology centres in Israel were searched for adult immunocompetent patients with CMV-associated thrombocytopenia, and five new cases were identified. The median age of the combined 30 patients was 33 years (range 18-80), 73% were men, 77% presented with CMV-related symptoms, 48% had enlarged spleens, 95% had atypical lymphocytes in peripheral blood and 68% had elevated transaminase levels. The response rate to first-line steroid-containing regimens was only 31%, whereas 11 patients who were treated with an anti-CMV agent had a response rate of 82%. Moreover, four patients received thrombopoietin receptor agonists (TPO-RA) to which three (75%) responded. Taken together, these distinctive features of a case with thrombocytopenia should alert to CMV infection as the source. While steroids were effective in less than one-third of the cases, both anti-CMV therapy and TPO-RA exhibited excellent efficacy, suggesting that those agents should be introduced earlier in the therapeutic course.

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Section: Resultsmentioning

confidence: 99%

Characteristics and outcomes of adults with cytomegalovirus‐associated thrombocytopenia: a case series and literature review

et al. 2020

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“…Aoki et al reported a case with a platelet count of 17,000 /μL ( 13 ), which was slightly higher than the present case (9,000 /μL). Acute CMV infection may also result in thrombocytopenia ( 14 , 15 ), which may have had a negative impact on the patient's degree of thrombocytopenia.…”

Section: Discussionmentioning

confidence: 99%

“…The use of systemic corticosteroids is an alternative choice for the treatment of thrombocytopenia induced by either HIV or CMV. However, there have been reports that demonstrate only a partial response or no response ( 13 , 14 ). In addition, steroid use is reported to be independently associated with the development of CMV colitis in immunocompetent hosts ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Severe Thrombocytopenia and Acute Cytomegalovirus Colitis during Primary Human Immunodeficiency Virus Infection

et al. 2016

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We herein report the case of a 25-year-old man who was referred to our hospital due to acute cytomegalovirus (CMV) colitis. The initial blood tests showed that the patient had concurrent primary human immunodeficiency virus (HIV) infection and severe thrombocytopenia. Raltegravir-based antiretroviral therapy (ART) was initiated without the use of ganciclovir or corticosteroids and resulted in a rapid clinical improvement. Platelet transfusions were only necessary for a short period, and subsequent colonoscopy revealed a completely healed ulcer. This case implies that ART alone could be effective for treating severe thrombocytopenia during primary HIV and CMV coinfection.

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The Role of Infection in Immune-Mediated Thrombocytopenia

David

2024

Infection and Autoimmunity

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

Cited by 10 publications

References 28 publications

Characteristics and outcomes of adults with cytomegalovirus‐associated thrombocytopenia: a case series and literature review

Characteristics and outcomes of adults with cytomegalovirus‐associated thrombocytopenia: a case series and literature review

Severe Thrombocytopenia and Acute Cytomegalovirus Colitis during Primary Human Immunodeficiency Virus Infection

The Role of Infection in Immune-Mediated Thrombocytopenia

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