Blood Res.  2018 Jun;53(2):110-116. 10.5045/br.2018.53.2.110.

Clinical characteristics and treatment courses for cytomegalovirus-associated thrombocytopenia in immunocompetent children after neonatal period

• Jin MJ
• Kim Y
• Choi EM
• Shim YJ
• Kim HS
• Suh JK
• Kim JY
• Lee KS
• Park SY
• Lee JM
• Hah JO

• KMID: 2451028
• DOI: http://doi.org/10.5045/br.2018.53.2.110

Abstract

BACKGROUND
Cytomegalovirus (CMV) causes severe diseases in premature infants and immunocompromised hosts, and antiviral therapy is often required for disease control. However, the clinical manifestations and treatment courses for CMV-associated thrombocytopenia in immunocompetent children are unclear.
METHODS
Medical records of the children who suffered from thrombocytopenia, and showed positive CMV polymerase chain reaction and CMV-like symptoms were retrospectively analyzed at three university hospitals in Daegu from January 2000 to March 2017. Patients suffering from leukemia, immunodeficiency, and other infections were excluded.
RESULTS
Among 1,065 children with thrombocytopenia, 29 (2.7%) displayed CMV-associated thrombocytopenia. The median age at diagnosis was 15 months and the median platelet count was 26,000/µL. They were classified into the CMV-induced thrombocytopenia (23/29) and CMV-related secondary immune thrombocytopenia (ITP, 6/29) groups. Fourteen subjects had hepatic dysfunction, four had Evans syndrome, two had pneumonitis, and one had gastritis. IVIG was used for 21 patients, and six patients among them showed recurrence, for whom IVIG or antiviral therapy was used. All, except one, recurrent or chronic cases belonged to the CMV-induced thrombocytopenia group. Antiviral therapy was used more frequently for the CMV-induced thrombocytopenia group (8/23, 34.8%) than for the CMV-related secondary ITP group (0/6); however, the results were not statistically significant (P=0.148).
CONCLUSION
CMV is a rare but unique etiology of thrombocytopenia, and observed even in healthy children after the neonatal period. About one-third patients need antiviral therapy for disease control. Further, CMV-induced thrombocytopenia is more complex than CMV-related secondary ITP.

Keyword

Cytomegalovirus; Immune thrombocytopenia; Immunocompetent; Ganciclovir; Valganciclovir

MeSH Terms

Child*
Cytomegalovirus
Daegu
Diagnosis
Ganciclovir
Gastritis
Hospitals, University
Humans
Immunocompromised Host
Immunoglobulins, Intravenous
Infant, Newborn
Infant, Premature
Leukemia
Medical Records
Platelet Count
Pneumonia
Polymerase Chain Reaction
Purpura, Thrombocytopenic, Idiopathic
Recurrence
Retrospective Studies
Thrombocytopenia*
Ganciclovir
Immunoglobulins, Intravenous

Figure

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  Fig. 1 Negative correlation between platelet count and urinary real-time quantitative CMV PCR titer during anti-viral treatment in CMV ITP children.Abbreviations: CMV, cytomegalovirus; IVIG, intravenous immunoglobulin; PCR, polymerase chain reaction.

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