Cytomegalovirus-Associated Septic Shock Leading to Disseminated Intravascular Coagulation

Cytomegalovirus (CMV) is typically asymptomatic in the immunocompetent but can cause deadly complications in the immunosuppressed. We report a rare case of a 58-year-old woman with stage IIIb chronic kidney disease, membranous glomerulonephritis, and diabetes mellitus who presented with profound weakness, watery diarrhea, and rectal bleeding. First managed for suspected infectious colitis, urinary tract infection, and acute kidney injury, she deteriorated quickly with confusion, hypotension, and fever. Severe metabolic acidosis, coagulopathy, and thrombocytopenia suggesting disseminated intravascular coagulation (DIC) were noted in laboratory results. The patient developed septic shock, needing intensive care, mechanical ventilation, and renal replacement therapy. CMV viral load was elevated, confirming the diagnosis of CMV-associated septic shock with DIC; the patient had an improved clinical response followed ganciclovir in conjunction with broad-spectrum antibiotics and extensive supportive care, including transfusions of fresh frozen plasma, cryoprecipitate, platelets, packed red blood cells, and vitamin K. Three weeks of targeted antiviral therapy and comprehensive supportive care allowed the patient's renal function, coagulation parameters, and clinical status to improve such that the patient could be safely discharged. This case highlights the need for early identification and very aggressive management of CMV infections in immunosuppressed patients to prevent life-threatening complications such as septic shock and DIC.