CMV-induced immune thrombocytopenia and excessive hematogones mimicking an acute B-precursor lymphoblastic leukemia

Area of Science:

• Pediatric Hematology
• Immunology
• Virology

Background:

• Hematogones are normal B-lymphocyte progenitor cells found in bone marrow.
• Increased hematogones are observed in various pediatric hematologic and nonhematologic conditions.
• Distinguishing reactive hematogones from neoplastic lymphoid cells is crucial in pediatric diagnostics.

Observation:

• A 3.5-month-old boy presented with immune thrombocytopenia secondary to acute cytomegalovirus (CMV) infection.
• Bone marrow examination revealed a significant proliferation of hematogones.
• The excessive hematogones mimicked the morphology of acute B-precursor lymphoblastic leukemia.

Findings:

• This is the first reported case of acute CMV infection-induced immune thrombocytopenia presenting with a prominent hematogone response.
• The findings underscore the potential for CMV infection to induce reactive changes in bone marrow lymphoid precursors.
• Morphological analysis confirmed the reactive nature of the hematogones, distinct from malignant lymphoid cells.

Implications:

• Clinicians should consider CMV infection in the differential diagnosis of infants with immune thrombocytopenia and bone marrow findings suggestive of leukemia.
• Understanding reactive hematogones is essential for accurate diagnosis and avoiding misclassification of pediatric hematologic disorders.
• This case expands the known spectrum of CMV-related hematologic manifestations in infants.