Simultaneous CMV Mononucleosis, Hemolytic Anemia with Negative Direct Coombs Test, and Thrombocytopenia
Abstract
Cytomegalovirus (CMV) is a viral agent that can cause various clinical signs according to the patient’s immune status. Primary CMV infection is usually asymptomatic in patients with a normal immune system and can lead to a self-limited, mononucleosis-like syndrome. We present a two and a half months old female with CMV mononucleosis, negative direct Coombs test, hemolytic anemia and thrombocytopenia. The patient presented with restlessness and cough and the examination revealed paleness, hepatosplenomegaly, and retarded growth and development. Laboratory tests showed leukocytosis, anemia, thrombocytopenia, and liver function disorder while peripheral smear showed CMV mononucleosis and reticulocytosis. Other results were CMV IgM (+), CMV PCR (+), direct Coombs (-), and haptoglobin level low. No treatment was given. The patient made a full clinical and laboratory recovery with no complications. In conclusion, cytomegalovirus infection should be considered in the differential diagnosis of hemolytic anemia and thrombocytopenia. Supportive care with untreated attitude is adequate for patients with normal immunity
References
- Taglietti F, Drapeau CM, Grilli E, Capone A, Noto P, Topino S, et al. Hemolytic anemia due to acute cytomegalovirus infection in an immunocompetent adult: A case report and review of the literature. J Med Case Rep 2010;4:334.
- Taylor GH. Cytomegalovirus. Am Fam Physician 2003;67:519-24.
- Demler GJ. Cytomegalovirus. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL (eds). Textbook of Pediatric Infectious Diseases, vol: 2, 5th ed. Philadelphia: Saunders E lsevier, Inc;2004:1912-32.
- Veldhuis W, Janssen M, Kortlandt W, van Houte A, van de Ree M. Coombs-negative severe haemolytic anaemia in an immunocompetent adult following cytomegalovirus infection. Eur J Clin Microbiol Infect Dis 2004;23:844-7.
- Horwitz CA, Skradski K, Reece E, Lewis FB, Schwartz B, Kelty R, et al. Haemolytic anaemia in previously healthy adult patients with CMV infections: Report of two cases and an evaluation of subclinical haemolysis in CMV mononucleosis. Scand J Haematol 1984;33:35-42.
- Murray JC, Bernini JC, Bijou HL, Rossmann SN, Mahoney DH Jr, Morad AB. Infantile cytomegalovirus-associated autoimmune hemolytic anemia. J Pediatr Hematol Oncol 2001;23:318-20.
CMV Mononükleozis, Direkt Coombs Testi (-) Hemolitik Anemi ve Mononükleozis, Direkt Coombs Testi (-) Hemolitik Anemi ve Trombositopeni Birlikteli rombositopeni Birlikteliği
Abstract
Sitomegalovirüs (CMV) hastanın immünolojik durumuna göre değişen çeşitli klinik belirtilerden sorumlu olan bir viral ajandır. Bağışıklık sistemi normal olan hastalarda, primer CMV enfeksiyonu genellikle asemptomatiktir veya kendini sınırlayan mononükleozis benzeri bir sendrom olarak gösterebilir. Bu yazıda; CMV mononükleozis, direkt Coombs testi (-) hemolitik anemi ve trombositopenisi olan iki buçuk aylık bir kız hasta sunulmuştur. Huzursuzluk ve öksürük nedeniyle getirilen hastanın solukluğu, hepatosplenomegalisi, büyüme ve gelişme geriliği vardı. Hastada lökositoz, anemi, trombositopeni, karaciğer fonksiyon bozukluğu, periferik yaymada CMV mononükleozisi ve retikülositozisi tespit edildi. CMV IgM (+), CMV PCR (+), direkt Coombs (-), haptoglobin düşük olarak bulundu. Hastaya her hangi bir tedavi verilmedi. Klinik ve laboratuvar olarak tamamen düzeldi ve herhangi bir komplikasyon gözlenmedi. Sonuç olarak; hemolitik anemi ve trombositopeni ayırıcı tanısında sitomegalovirüs enfeksiyonu da düşünülmeli, bağışıklığı yeterli olan kişilerde gerektiğinde destekleyici bakım ile tedavisiz izlem politikası uygulanmalıdır.
References
- Taglietti F, Drapeau CM, Grilli E, Capone A, Noto P, Topino S, et al. Hemolytic anemia due to acute cytomegalovirus infection in an immunocompetent adult: A case report and review of the literature. J Med Case Rep 2010;4:334.
- Taylor GH. Cytomegalovirus. Am Fam Physician 2003;67:519-24.
- Demler GJ. Cytomegalovirus. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL (eds). Textbook of Pediatric Infectious Diseases, vol: 2, 5th ed. Philadelphia: Saunders E lsevier, Inc;2004:1912-32.
- Veldhuis W, Janssen M, Kortlandt W, van Houte A, van de Ree M. Coombs-negative severe haemolytic anaemia in an immunocompetent adult following cytomegalovirus infection. Eur J Clin Microbiol Infect Dis 2004;23:844-7.
- Horwitz CA, Skradski K, Reece E, Lewis FB, Schwartz B, Kelty R, et al. Haemolytic anaemia in previously healthy adult patients with CMV infections: Report of two cases and an evaluation of subclinical haemolysis in CMV mononucleosis. Scand J Haematol 1984;33:35-42.
- Murray JC, Bernini JC, Bijou HL, Rossmann SN, Mahoney DH Jr, Morad AB. Infantile cytomegalovirus-associated autoimmune hemolytic anemia. J Pediatr Hematol Oncol 2001;23:318-20.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Other ID | JA24PC78SR |
| Journal Section | Case Report |
| Authors | |
| Publication Date | April 1, 2016 |
| Submission Date | April 1, 2016 |
| Published in Issue | Year 2016 Volume: 10 Issue: 1 |
The publication language of Turkish Journal of Pediatric Disease is English.
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