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Splenic Infarction in Acute Cytomegalovirus and Human Parvovirus Concomitant Infection. Case Rep Infect Dis 2019; 2018:7027656. [PMID: 30631613 PMCID: PMC6304844 DOI: 10.1155/2018/7027656] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/14/2018] [Indexed: 11/17/2022] Open
Abstract
We present a case report of a 35-year-old woman who had splenic infarction. She had persistent high fever, systemic joint pain, and abnormal liver function. She was diagnosed with cytomegalovirus and human parvovirus B19 concomitant infection. Her coagulopathy test revealed no abnormal results. She was treated with intravenous ganciclovir for 13 days; consequently, her splenic infarction improved after 7 weeks. As per our knowledge, this is the first case of cytomegalovirus and parvovirus B19 coinfection complicated by splenic infarction. Cytomegalovirus and parvovirus B19 may induce a hypercoagulation state during the acute phase.
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Cytomegalovirus-associated splanchnic vein thrombosis in immunocompetent patients: A systematic review. Thromb Res 2018; 168:104-113. [DOI: 10.1016/j.thromres.2018.06.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/18/2018] [Accepted: 06/16/2018] [Indexed: 02/07/2023]
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Ceccarelli M, Venanzi Rullo E, Nunnari G. Risk factors of venous thrombo-embolism during cytomegalovirus infection in immunocompetent individuals. A systematic review. Eur J Clin Microbiol Infect Dis 2018; 37:381-390. [PMID: 29344839 DOI: 10.1007/s10096-018-3185-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 01/03/2018] [Indexed: 12/18/2022]
Abstract
Most of the effects and complications of cytomegalovirus (CMV) infection are still unknown, even though its tropism for the endothelium has been extensively investigated. In fact, CMV is suspected to be a cause of venous thrombo-embolism (VTE) since 1974, but there is still no consensus about the management of CMV-related thrombosis and how to prevent it. Cytomegalovirus-related thrombosis has been reported mostly in immunocompromised patients, rarely in immunocompetent individuals. In order to identify potential risk factors of CMV-related thrombosis, we performed a systematic review of the literature regarding immunocompetent patients with cytomegalovirus infection and thrombosis. We found 115 cases with a mean age of 37.36 years (SD ± 16.43 years). Almost half the female patients were assuming EP contraception at the time of the event, and almost half the patients were affected by a coagulation disorder. Interestingly, just two women and four men had no risk factor for thrombosis other than the CMV infection at the time of the event. In conclusion, coagulation disorders and EP contraception have to be taken into a great deal of consideration in patients with CMV infection, since they could be important risk factors for VTE. Knowing the correlation with coagulation disorders, the use of anticoagulation drugs cannot be considered overtreatment. It was not feasible to determine the usefulness of an antiviral treatment. Further studies, even randomized ones, are required to determine the usefulness of antiviral drugs and the real prevalence of CMV-related VTE.
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Affiliation(s)
- Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Via Consolare Valeria, 1, 98125, Messina, ME, Italy.
| | - Emmanuele Venanzi Rullo
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Via Consolare Valeria, 1, 98125, Messina, ME, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, University of Messina, Via Consolare Valeria, 1, 98125, Messina, ME, Italy
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Kelkar AH, Jacob KS, Yousif EB, Farrell JJ. Venous thromboembolism related to cytomegalovirus infection: A case report and literature review. Medicine (Baltimore) 2017; 96:e9336. [PMID: 29390512 PMCID: PMC5758214 DOI: 10.1097/md.0000000000009336] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Herein, we present a case of seemingly unprovoked portal vein thrombosis (PVT) occurring in the context of an acute cytomegalovirus (CMV) infection and prolonged debilitating fatigue. PATIENT CONCERNS A 46-year-old male airline pilot presented with a 2 week history of abdominal pain, nausea, vomiting, watery diarrhea, and daily recurrent fevers. This was in the context of progressive, debilitating fatigue for 3 months forcing the patient to leave his job. DIAGNOSES Computed tomography of the abdomen revealed PVT, which was managed initially by heparin infusion. Cefepime was ordered for broad-spectrum antibiotic management of sepsis and possible septic thrombosis. Further workup exposed elevated transaminases consistent with mild hepatitis without synthetic dysfunction and colonoscopy revealed colitis. A comprehensive evaluation for liver disease was notable for a markedly elevated ferritin level. Spiking fevers and neutrophilia persisted for several days despite empiric antimicrobial treatment, but eventually resolved. The remainder of the workup was negative except for positive CMV IgM titer and viral load. This raised suspicion for a hypercoagulable state caused by CMV hepatitis with CMV-induced PVT. Heparin was transitioned to warfarin at the time of discharge. INTERVENTIONS Given the patient's immunocompetent state and resolution of fevers, antiviral therapy for CMV infection was not initiated. OUTCOMES The patient continued to improve with a normalization of the serum ferritin level and anticoagulation therapy was stopped after 6 months. LESSONS There is mounting support for infectious causes of venous thromboembolism (VTE) based on existing molecular biology and clinical research. Meta-analysis of existing data showed that between 1.9% and 9.1% of patients hospitalized with VTE had concurrent acute CMV infection. Theoretical mechanisms for this association include transient formation of antiphospholipid antibodies, transient formation of antibodies targeting CMV capsule phospholipids with procoagulant properties, and direct infection of the endothelial cells. We hope this case will serve as a reminder to consider CMV as a transient cause of PVT and VTE, particularly in light of 2016 guidelines for unprovoked VTE recommending lifelong anticoagulation. We also plan to prospectively study the association of unprovoked VTE and acute CMV infection in our own hospital system.
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Affiliation(s)
- Amar H. Kelkar
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Kavitha S. Jacob
- Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, IL
| | - Eman B. Yousif
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - John J. Farrell
- Department of Infectious Diseases, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
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Abdel-Wahab N, Lopez-Olivo MA, Pinto-Patarroyo GP, Suarez-Almazor ME. Systematic review of case reports of antiphospholipid syndrome following infection. Lupus 2016; 25:1520-1531. [PMID: 27060064 PMCID: PMC7508159 DOI: 10.1177/0961203316640912] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/29/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to conduct a systematic review of case reports documenting the development of antiphospholipid syndrome or antiphospholipid syndrome-related features after an infection. METHODS We searched Medline, EMBASE, Web of Science, PubMed ePubs, and The Cochrane Library - CENTRAL through March 2015 without restrictions. Studies reporting cases of antiphospholipid syndrome or antiphospholipid syndrome-related features following an infection were included. RESULTS Two hundred and fifty-nine publications met inclusion criteria, reporting on 293 cases. Three different groups of patients were identified; group 1 included patients who fulfilled the criteria for definitive antiphospholipid syndrome (24.6%), group 2 included patients who developed transient antiphospholipid antibodies with thromboembolic phenomena (43.7%), and group 3 included patients who developed transient antiphospholipid antibodies without thromboembolic events (31.7%). The most common preceding infection was viral (55.6%). In cases that developed thromboembolic events Human immunodeficiency and Hepatitis C viruses were the most frequently reported. Parvovirus B19 was the most common in cases that developed antibodies without thromboembolic events. Hematological manifestations and peripheral thrombosis were the most common clinical manifestations. Positive anticardiolipin antibodies were the most frequent antibodies reported, primarily coexisting IgG and IgM isotypes. Few patients in groups 1 and 2 had persistent antiphospholipid antibodies for more than 6 months. Outcome was variable with some cases reporting persistent antiphospholipid syndrome features and others achieving complete resolution of clinical events. CONCLUSIONS Development of antiphospholipid antibodies with all traditional manifestations of antiphospholipid syndrome were observed after variety of infections, most frequently after chronic viral infections with Human immunodeficiency and Hepatitis C. The causal relationship between infection and antiphospholipid syndrome cannot be established, but the possible contribution of various infections in the pathogenesis of antiphospholipid syndrome need further longitudinal and controlled studies to establish the incidence, and better quantify the risk and the outcomes of antiphospholipid-related events after infection.
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Affiliation(s)
- N Abdel-Wahab
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Rheumatology and Rehabilitation Department, Assiut University Hospitals, Assiut, Egypt
| | - M A Lopez-Olivo
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - G P Pinto-Patarroyo
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, USA
| | - M E Suarez-Almazor
- Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Müller NF, Schampera M, Jahn G, Malek NP, Berg CP, Hamprecht K. Case report: severe cytomegalovirus primary infection in an immunocompetent adult with disseminated intravascular coagulation treated with valganciclovir. BMC Infect Dis 2016; 16:19. [PMID: 26787617 PMCID: PMC4719720 DOI: 10.1186/s12879-016-1343-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 01/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disseminated intravascular coagulation (DIC) is a very rare complication of disseminated cytomegalovirus (CMV) infection. So far it is mainly described for immunocompromised patients. CASE PRESENTATION A 49-year-old immunocompetent Caucasian male presented with sudden onset of fever and DIC due to primary CMV infection, which was treated with Valganciclovir. CMV-specific IgG-avidity and epithelial cell-specific neutralisation-capacity developed five weeks after onset of symptoms. We describe the first case of an immunocompetent patient suffering from DIC due to a CMV primary infection successfully treated with Valganciclovir. CONCLUSIONS Primary CMV infection can occur accompanied with life threatening complications even in immunocompetent patients. Immediate treatment with Valganciclovir should be considered as an early treatment of choice in severe cases since specific neutralisation capacity might need several weeks to develop.
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Affiliation(s)
- Niklas F Müller
- Department of Internal Medicine I, University Hospital of Tuebingen, D-72076 Tuebingen, Germany
| | - Matthias Schampera
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tuebingen, D-72076 Tuebingen, Germany
| | - Gerhard Jahn
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tuebingen, D-72076 Tuebingen, Germany
| | - Nisar P Malek
- Department of Internal Medicine I, University Hospital of Tuebingen, D-72076 Tuebingen, Germany
| | - Christoph P Berg
- Department of Internal Medicine I, University Hospital of Tuebingen, D-72076 Tuebingen, Germany
| | - Klaus Hamprecht
- Institute of Medical Virology and Epidemiology of Viral Diseases, University Hospital of Tuebingen, D-72076 Tuebingen, Germany.
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Sherman S, Eytan O, Justo D. Thrombosis associated with acute cytomegalovirus infection: a narrative review. Arch Med Sci 2014; 10:1186-90. [PMID: 25624857 PMCID: PMC4296074 DOI: 10.5114/aoms.2014.47828] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Revised: 09/28/2013] [Accepted: 10/18/2013] [Indexed: 01/14/2023] Open
Abstract
Thrombosis associated with acute cytomegalovirus infection has been reported many times in the literature since the mid 1980s - mainly in case reports and in small case series, but also in four controlled studies. Still, many physicians are unaware of this association although acute cytomegalovirus infection diagnosis in a thrombosis patient may warrant antiviral therapy and may affect anticoagulation therapy duration. Accordingly, the clinical characteristics of patients with thrombosis and acute cytomegalovirus infection are reviewed, and the current knowledge concerning this unique association is presented herein. We believe it is time to add acute cytomegalovirus infection to the list of thrombosis triggers.
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Affiliation(s)
- Shany Sherman
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ori Eytan
- Department of Dermatology, Sourasky Medical Center, Tel-Aviv, Israel
| | - Dan Justo
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Internal Medicine E, Sheba Medical Center, Tel-Hashomer, Israel
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Protopapa MN, Velissaris D, Mougiou A, Siagkris D. Cytomegalovirus-associated splenic infarcts in an adult immune-competent man: a case report and review of the literature. J Med Case Rep 2014; 8:85. [PMID: 24594283 PMCID: PMC3978118 DOI: 10.1186/1752-1947-8-85] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 12/23/2013] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Cytomegalovirus-associated thrombosis has been extensively reported in the medical literature, mainly in immune-compromised patients. However, the association with splenic infarcts has been rarely mentioned. CASE PRESENTATION We report the case of a 38-year-old Caucasian man of Hellenic origin with acute cytomegalovirus infection presenting with spontaneous splenic infarcts. Echocardiography did not show any vegetations or mural thrombi. Anticoagulation treatment was not considered due to implication of minor vessels and since cytomegalovirus was the probable trigger for thrombosis in this patient. CONCLUSIONS This case report serves as additional evidence for the role of cytomegalovirus in thrombosis.
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Sherman S, Justo D, Engel T, Yossepowitch O, Bregman N, Gadoth A, Paran Y. Cytomegalovirus-associated cerebral sinus vein thrombosis. J Med Virol 2012; 84:1934-6. [DOI: 10.1002/jmv.23424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Cull E, Stein BL. Splenic infarction, warm autoimmune hemolytic anemia and antiphospholipid antibodies in a patient with infectious mononucleosis. Int J Hematol 2012; 95:573-6. [PMID: 22407854 DOI: 10.1007/s12185-012-1047-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 02/27/2012] [Accepted: 02/28/2012] [Indexed: 02/04/2023]
Abstract
An 18-year-old woman with infectious mononucleosis developed splenic infarction and severe anemia. Evaluation of her anemia revealed a warm autoantibody and a persistently prolonged partial thromboplastin time that ultimately led to the identification of antiphospholipid antibodies. Although the warm autoantibody disappeared after 2 months, the antiphospholipid antibodies remained persistently positive. To our knowledge, this is the first case report in the literature of this specific constellation of findings, with infectious mononucleosis, warm antibody hemolytic anemia, splenic infarction and persistently positive, high-titer antiphospholipid antibodies occurring in an individual patient.
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Affiliation(s)
- Elizabeth Cull
- Division of Hematology/Oncology, Department of Medicine, Feinberg School of Medicine and Northwestern Memorial Hospital, Northwestern University, Chicago, IL 60611, USA
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