Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case report
Abstract Background Thrombotic thrombocytopenic purpura (TTP) is a rare, potentially fatal disease with multisystem involvement. Cytomegalovirus (CMV) infection as a cause of refractory TTP, has been reported only in immunocompromised individuals. We report a case of CMV-induced refractory TTP in an...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-05-01
|
| Series: | BMC Infectious Diseases |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12879-019-4037-9 |
| _version_ | 1818060061628432384 |
|---|---|
| author | Medhini Boteju Praveen Weeratunga Ahalyaa Sivashangar Thashi Chang |
| author_facet | Medhini Boteju Praveen Weeratunga Ahalyaa Sivashangar Thashi Chang |
| author_sort | Medhini Boteju |
| collection | DOAJ |
| description | Abstract Background Thrombotic thrombocytopenic purpura (TTP) is a rare, potentially fatal disease with multisystem involvement. Cytomegalovirus (CMV) infection as a cause of refractory TTP, has been reported only in immunocompromised individuals. We report a case of CMV-induced refractory TTP in an immunocompetent individual. Case presentation A 35-year-old, previously healthy Sri Lankan man, presented with fever for 3 days with gum bleeding and progressive drowsiness. His Glasgow coma scale score was 10/15. He did not have papilloedema or neck stiffness. Laboratory evaluation showed a severe thrombocytopenia with microangiopathic haemolytic anaemia. There was marginal renal impairment and normal coagulation profile. Non-contrast CT scan of brain was normal. A diagnosis of thrombotic thrombocytopenic purpura was made. Despite daily plasma exchanges and high-dose steroids, he failed to achieve the expected therapeutic response, thus demonstrating refractory TTP. On exploring for possible causes of refractoriness to treatment, a clinically significant PCR titre of CMV was detected. Treatment of CMV infection lead to complete recovery of TTP. His disease course was further complicated with spontaneous spinal haemorrhage leading to neurological sequelae. Discussion and conclusions This is the first report of CMV induced refractory TTP in an immunocompetent adult. It is also the first report of clinically significant spontaneous spinal haematoma in TTP. These two rare occurrences should be considered when patients with refractory TTP do not improve as expected. |
| first_indexed | 2024-12-10T13:26:26Z |
| format | Article |
| id | doaj.art-1063a05fb9024f1a911ccce407959076 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-10T13:26:26Z |
| publishDate | 2019-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-1063a05fb9024f1a911ccce4079590762022-12-22T01:47:07ZengBMCBMC Infectious Diseases1471-23342019-05-011911410.1186/s12879-019-4037-9Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case reportMedhini Boteju0Praveen Weeratunga1Ahalyaa Sivashangar2Thashi Chang3University Medical Unit, National Hospital of Sri LankaUniversity Medical Unit, National Hospital of Sri LankaUniversity Medical Unit, National Hospital of Sri LankaUniversity Medical Unit, National Hospital of Sri LankaAbstract Background Thrombotic thrombocytopenic purpura (TTP) is a rare, potentially fatal disease with multisystem involvement. Cytomegalovirus (CMV) infection as a cause of refractory TTP, has been reported only in immunocompromised individuals. We report a case of CMV-induced refractory TTP in an immunocompetent individual. Case presentation A 35-year-old, previously healthy Sri Lankan man, presented with fever for 3 days with gum bleeding and progressive drowsiness. His Glasgow coma scale score was 10/15. He did not have papilloedema or neck stiffness. Laboratory evaluation showed a severe thrombocytopenia with microangiopathic haemolytic anaemia. There was marginal renal impairment and normal coagulation profile. Non-contrast CT scan of brain was normal. A diagnosis of thrombotic thrombocytopenic purpura was made. Despite daily plasma exchanges and high-dose steroids, he failed to achieve the expected therapeutic response, thus demonstrating refractory TTP. On exploring for possible causes of refractoriness to treatment, a clinically significant PCR titre of CMV was detected. Treatment of CMV infection lead to complete recovery of TTP. His disease course was further complicated with spontaneous spinal haemorrhage leading to neurological sequelae. Discussion and conclusions This is the first report of CMV induced refractory TTP in an immunocompetent adult. It is also the first report of clinically significant spontaneous spinal haematoma in TTP. These two rare occurrences should be considered when patients with refractory TTP do not improve as expected.http://link.springer.com/article/10.1186/s12879-019-4037-9Cytomegalo-virusRefractory thrombotic thrombocytopenic purpura |
| spellingShingle | Medhini Boteju Praveen Weeratunga Ahalyaa Sivashangar Thashi Chang Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case report BMC Infectious Diseases Cytomegalo-virus Refractory thrombotic thrombocytopenic purpura |
| title | Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case report |
| title_full | Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case report |
| title_fullStr | Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case report |
| title_full_unstemmed | Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case report |
| title_short | Cytomegalovirus induced refractory TTP in an immunocompetent individual: a case report |
| title_sort | cytomegalovirus induced refractory ttp in an immunocompetent individual a case report |
| topic | Cytomegalo-virus Refractory thrombotic thrombocytopenic purpura |
| url | http://link.springer.com/article/10.1186/s12879-019-4037-9 |
| work_keys_str_mv | AT medhiniboteju cytomegalovirusinducedrefractoryttpinanimmunocompetentindividualacasereport AT praveenweeratunga cytomegalovirusinducedrefractoryttpinanimmunocompetentindividualacasereport AT ahalyaasivashangar cytomegalovirusinducedrefractoryttpinanimmunocompetentindividualacasereport AT thashichang cytomegalovirusinducedrefractoryttpinanimmunocompetentindividualacasereport |