Transfusion-associated cytomegalovirus mononucleosis

Area of Science:

• Infectious Diseases
• Transfusion Medicine
• Virology

Background:

• Transfusion-associated cytomegalovirus (TCM) mononucleosis is typically associated with extracorporeal circulation in cardiac surgery.
• This study investigates TCM mononucleosis as a complication following trauma surgery.

Observation:

• Three cases of TCM mononucleosis post-trauma were identified within a year, involving both massive and limited blood transfusions.
• Patients presented with hectic fever but were otherwise asymptomatic, lacking classic infectious mononucleosis symptoms.
• Diagnostic challenges included differentiating from undrained abscesses due to delayed onset post-surgery.

Findings:

• Key laboratory clues included atypical lymphocytosis, cold agglutinins, rheumatoid factor, and moderate hepatic dysfunction.
• Spleen scan defects and a false-positive monospot test initially suggested septic complications or other diagnoses.
• The illness was self-limited, emphasizing the importance of accurate serologic diagnosis.

Implications:

• Failure to consider TCM mononucleosis in post-trauma patients can lead to misdiagnosis and unnecessary surgical procedures.
• Awareness of this differential diagnosis is vital for appropriate patient management.
• Other viral agents causing similar syndromes should also be considered.