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Unusual manifestations of primary cytomegalovirus infection in patients without HIV infection and without organ transplants
Author(s) -
Crowley Brendan,
Dempsey Jed,
Olujohungbe Ade,
Khan Abdul,
Mutton Ken,
Hart C.A.
Publication year - 2002
Publication title -
journal of medical virology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.782
H-Index - 121
eISSN - 1096-9071
pISSN - 0146-6615
DOI - 10.1002/jmv.10200
Subject(s) - medicine , lymphocytosis , cytomegalovirus , immunology , immunosuppression , pancytopenia , ganciclovir , thrombocytopenic purpura , vasculitis , seroconversion , ulcerative colitis , disease , viral disease , human cytomegalovirus , herpesviridae , virus , immune system , bone marrow
Primary cytomegalovirus (CMV) infection with marked constitutional symptoms is rare in immunocompetent individuals and in those with iatrogenic immunosuppression, except transplant recipients. Four patients admitted to hospital with clinical illnesses associated with primary CMV infection were identified over a 12‐month period. Their medical records were reviewed with regard to clinical and laboratory data, and outcome. Primary CMV infection was defined by the concomitant presence of CMV IgM and low avidity CMV IgG antibody. Of two patients with no known underlying illness, one presented with thrombocytopenic purpura and the other with vasculitis. Two patients receiving immunosuppressants for underlying ulcerative colitis presented with CMV‐induced pancytopenia and CMV colitis. Atypical lymphocytosis was a feature on blood film examination in three of the four cases. One patient with disseminated CMV infection died of progressive multiorgan failure despite antiviral treatment. CMV disease following primary CMV infection should be considered in otherwise immunocompetent individuals with atypical lymphocytosis on blood film analysis, and particularly in patients on immunosuppressants such as those with ulcerative colitis, since early diagnosis and treatment with antiviral drugs may improve outcome. J. Med. Virol. 68: 237–240, 2002. © 2002 Wiley‐Liss, Inc.