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Pancytopenia secondary to cytomegalovirus reactivation

Justin Ruey Tse1, Gan Xon Ng

  • 1David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.

BMJ Case Reports
|January 15, 2014
PubMed

Insights

Cytomegalovirus (CMV) reactivation caused isolated pancytopenia in a patient with microscopic polyangiitis. Prompt ganciclovir treatment led to complete blood count recovery, demonstrating effective CMV management.

Area of Science:

  • Infectious Diseases
  • Hematology
  • Immunology

Background:

  • Microscopic polyangiitis (MPA) is a systemic vasculitis often treated with immunosuppressive agents.
  • Immunosuppression increases the risk of opportunistic infections, such as cytomegalovirus (CMV).

Observation:

  • A 64-year-old woman with MPA presented with a severe leg ulcer and developed pancytopenia.
  • Her immunosuppressive regimen included prednisone, azathioprine, cyclophosphamide, and rituximab.
  • Diagnostic work-up revealed cytomegalovirus (CMV) reactivation as the cause of pancytopenia, with viral load at 899,100 copies/mL.

Findings:

  • Treatment with intravenous ganciclovir, followed by an oral regimen, was initiated.
  • The patient showed a significant response to antiviral therapy.
  • Complete hematologic recovery was observed, with normalization of white blood cell count, hemoglobin, and platelet count.

Implications:

  • This case highlights the importance of considering opportunistic infections like CMV reactivation in immunosuppressed patients presenting with cytopenias.
  • Early diagnosis and prompt antiviral treatment are crucial for managing CMV-induced pancytopenia.
  • Effective management of CMV reactivation can lead to full hematologic recovery in immunocompromised individuals.

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