Severe leukemoid reaction in a preterm infant with congenital cytomegalovirus infection

Renal Involvement in Congenital Cytomegalovirus Infection: A Systematic Review

BACKGROUND

Congenital cytomegalovirus (cCMV) infection is the most frequent mother-to-child transmitted infection worldwide and a prevalent cause of neonatal disease and long-term morbidity. The kidney is a target organ for CMV, which replicates in renal tubules and is excreted in large quantities in urine for years in children with cCMV infection. Nonetheless, kidney disease has rarely been reported in cCMV-infected patients.

OBJECTIVE

We aimed to describe the available data on renal involvement in patients with cCMV infection at the pathologic, functional, anatomical, and/or clinical levels.

METHODS

A systematic search was performed in the MEDLINE/PubMed, SCOPUS, and Cochrane databases. Studies describing any renal involvement in fetuses or neonates aged ≤3 weeks at diagnosis of microbiologically confirmed cCMV infection were eligible.

RESULTS

Twenty-four articles were included, with a very low level of evidence. Pathologic findings in autopsy studies universally described CMV typical inclusion bodies in tubular cells. No functional studies were identified. cCMV infection was not associated with an increased risk of kidney malformations. Congenital nephrotic syndrome was the most common clinical condition associated with cCMV, but a causal relationship cannot be established.

CONCLUSIONS

Typical pathological features of cCMV infection are very common in renal tissue, but they do not seem to entail significant consequences at the anatomical or clinical levels.

Leukemoid reaction with severe thrombocytopenia in a dying patient: a case report and literature review

Leukemoid reaction complicated by thrombocytopenia is rare, usually seen in patients with malignant conditions, and is often associated with poor prognosis. Here, the case of a 28-year-old healthy female without exceptional past medical history, who suffered from severe vaginal infection, is reported. Although symptoms improved, the white blood cell (WBC) count continued to increase up to 78 460 cells/µl, however, the patient continued to improve and the outcome was good. The case revealed that an increasing WBC count may not change in synchrony with clinical symptoms. When faced with this scenario, procalcitonin measurements may play an important role in differentiating diagnosis and guiding treatment.

Discordant Transient Extreme Hyperleukocytosis in Dichorionic Diamniotic Twins: The Role of the Sex?

Although a leukemoid reaction is a well-recognized phenomenon in the neonatal intensive care unit, transient extreme hyperleukocytosis in premature infants is rare. The exact mechanism is still unclear and several hypotheses are documented in the literature. In this case report, we describe 2 dichorionic diamniotic premature twins, of whom the 2 girls had extreme hyperleukocytosis, whereas their siblings did not, emphasizing the potentially important role of the sex in this phenomena.

Enterococcus fecalis Sepsis and Leukemoid Reaction: An Unusual Association at Birth

Enterococcus fecalis is a nosocomial, opportunistic pathogen, known to cause late-onset sepsis in preterm neonates and is notorious for its association with high mortality and resistance to commonly used antibiotics, such as penicillin, ampicillin, aminoglycosides, and vancomycin. Neonatal leukemoid reaction, defined as the white blood cell count ≥50×10/L or absolute neutrophil count >30×10/L, is a poor prognostic factor in chorioamnionitis. Occurrence of neonatal leukemoid reaction in E. fecalis-mediated sepsis is rare. We report development of leukemoid reaction in a preterm, extremely low-birth-weight neonate with early-onset sepsis caused by E. fecalis that was resistant to ampicillin and aminoglycosides.