Immune Thrombocytopenic Purpura Secondary to Cytomegalovirus (CMV) Infection: A Clinical Case

Immune thrombocytopenic purpura (ITP) is an autoimmune condition characterized by a reduced platelet count due to enhanced peripheral destruction and impaired platelet production. While thrombocytopenia is a well-documented complication of various viral infections, cytomegalovirus (CMV), a member of the Herpesviridae family, is primarily associated with infections in immunocompromised patients and is rarely implicated in causing severe thrombocytopenia in immunocompetent patients. This article aims to highlight the importance of considering CMV as a significant etiological factor in ITP, particularly in cases of asymptomatic thrombocytopenia. A 34-year-old male presented to the emergency department with a one-week history of progressively worsening erythematous macules on the lower extremities, extending proximally, accompanied by spontaneous ecchymoses, ulcerative and hemorrhagic aphthous lesions in the oral cavity and recurrent episodes of epistaxis. Physical examination revealed petechiae on the ear pavilions, face, trunk, back, upper limbs, abdomen and lower limbs. Intraorally, multiple ulcers and violaceous lesions were observed on the buccal mucosa and tonsillar regions. Additionally, the patient exhibited a localized area of ecchymosis with a central crusted lesion on the right lower leg. Serologic testing for CMV was positive and targeted antiviral therapy was initiated. CMV infection can lead to severe thrombocytopenia in otherwise healthy adults, despite diagnostic challenges. These challenges arise due to the low incidence of severe CMV disease, its diverse clinical manifestations, and its ability to mimic symptoms of other common illnesses. In cases of ITP that resist standard treatments, antiviral therapy may be necessary and should be promptly initiated if CMV infection is confirmed. CMV infection should be included in the differential diagnosis for severe thrombocytopenia in healthy adults, especially following a recent viral infection.