Cytomegalovirus-associated pancytopenia in a four-month-old infant: a case report

Cytomegalovirus (CMV) is a beta-herpes virus causing common infections, often asymptomatic in healthy individuals. However, it poses increased risks to immunocompromised individuals and can cause congenital infections, leading to severe disabilities. CMV infection can cause significant hematological abnormality. A four-month-old female infant was admitted for decreased feeding for two days. She was severely pale, without hepatosplenomegaly. In initial laboratory investigations hemoglobin, platelet count, and white blood cells were decreased. The patient was transfused with whole blood and referred to a tertiary care center. Further workup, including bone marrow biopsy, showed hypocellular marrow. The Urine CMV Polymerase Chain Reaction (PCR) test returned highly positive with a viral load of 1,700,000 copies/mL. This patient was diagnosed with CMV-associated bone marrow suppression, and she was prescribed valganciclovir at a dosage of 16 mg/kg/dose every 12 h for 6 months. She had shown significant hematologic parameter improvement during subsequent follow-up. Pancytopenia in infancy should include a differential diagnosis for CMV infection. The early recognition and correct infection management, including antiviral therapy and symptomatic treatment, yield a better prognosis.