Venous Thrombosis Secondary to Acute Cytomegalovirus Infection in an Immunocompetent Host: Consideration for New Screening Guidelines

Abstract

Serious thrombotic complications associated with an acute cytomegalovirus (CMV) infection in immunocompromised and immunocompetent patients are becoming increasingly recognized. While typically asymptomatic and self-limiting, an acute CMV infection appears to demonstrate a rare propensity for a vascular thrombosis, such as deep vein thrombosis (DVT), thrombophlebitis, and pulmonary embolism (PE). It remains unclear whether other predisposing factors play a role in its pathogenesis. We report the case of a young, immunocompetent male with extensive lower extremity DVT who was coincidentally found to be CMV-immunoglobulin M (IgM) seropositive. In light of the increasing prevalence of CMV-associated thrombotic events, we reviewed the current literature on its incidence, pathophysiology, clinical features, and thrombophilia screening to consider the possibility of CMV seropositivity as an independent risk factor for vascular events. This may have repercussions for screening guidelines and preventive strategies in those with active CMV infection.

Serum Proteomics Reveals Alterations in Protease Activity, Axon Guidance, and Visual Phototransduction Pathways in Infants With In Utero Exposure to Zika Virus Without Congenital Zika Syndrome

“…Proteins related to venous thrombosis and blood coagulation, such as Coagulation factor VII (F7) and Fibrinogen alpha chain (FGA), were upregulated in the ZIKV group. The relationship between viral infections and changes in coagulation processes has already been described for ZIKV (Ramacciotti et al, 2019) and other viruses (Kimmel, 1967;Bibas et al, 2011;da Costa et al, 2012;Goeijenbier et al, 2012;Roy et al, 2013;Wang et al, 2015;Wijarnpreecha et al, 2017;Marques et al, 2017; Neppelenbroek et al, 2018;Ngu et al, 2018;Ramacciotti et al, 2019). After the occurrence of isolated cases of venous thrombosis in patients who had a positive diagnosis for ZIKV, Ramacciotti et al (2019) assessed blood D-dimer levels, which are usually monitored for the diagnosis of deep venous thrombosis, of 172 patients who had ZIKV or chikungunya, without cross-infection.…”

Haematological parameters and coagulation in umbilical cord blood following COVID-19 infection in pregnancy

“…Several viruses, including Human Immunodeficiency Virus and Cytomegalovirus, cause hypercoagulability and thrombotic complications [22] , [23] , [24] , [25] , [26] . Moreover, maternal infections with Cytomegalovirus, Parvovirus B-19 and Rubella are associated with haematological abnormalities including thrombocytopenia and anaemia in the fetus [27] , [28] , [29] .…”

Cytomegalovirus-induced vasculopathy and anogenital skin ulcers in a patient with multiple myeloma

“…In the later stages or severe infection, cutaneous ulceration may develop 4 . There are many reports describing CMV-induced cutaneous vasculopathy and venous thrombosis 5, 6. With regard to the role of CMV in thrombogenesis, it is believed that vascular endothelial inflammation and vasculitis caused by CMV infection leads to procoagulant activity.…”

“…With regard to the role of CMV in thrombogenesis, it is believed that vascular endothelial inflammation and vasculitis caused by CMV infection leads to procoagulant activity. Alternatively, the virus may acquire procoagulant properties, such as procoagulant phospholipid and tissue factor, during replication inside endothelial cells and induce thrombogenesis by upregulating thrombin production and by facilitating the activation of factor X 6 …”

“…CMV-induced cutaneous vasculopathy is typically observed in the extremities 6 . In patients positive for HIV, skin lesions sometimes manifest as mucocutaneous ulcers in perianal lesions.…”