Korean J Hematol 2010; 45(1):
Published online March 31, 2010
https://doi.org/10.5045/kjh.2010.45.1.29
© The Korean Society of Hematology
1Department of Pediatrics, The Chungnam National University College of Medicine, Daejeon, Korea.
2Department of Pediatrics, School of Medicine, Hanyang University Medical Center, Seoul, Korea.
3Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
4Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.
Correspondence to : Correspondence to Sun-Young Kim, M.D. Department of Pediatrics, School of Medicine, Hanyang University Medical Center, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea. Tel: +82-2-2290-9787, Fax: +82-2-2297-2380, nel1205@hanmail.net
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Up to 90% of neonates with congenital or perinatal cytomegalovirus (CMV) infection are asymptomatic, and little is known about CMV-associated thrombocytopenia after the neonatal period. We investigated the clinical findings of a series of infants diagnosed with CMV infection and thrombocytopenia.
From July 2005 to July 2008, infants aged younger than 6 months with thrombocytopenia were screened for CMV infection, using CMV IgM. Those who were positive for CMV IgM were then tested for CMV IgG via polymerase chain reaction (PCR) for CMV and CMV pp65 Ag and urine culture. Brain magnetic resonance imaging (MRI) and otologic and ophthalmologic evaluations were also performed.
Twenty-one patients aged between 1 and 6 months (11 boys and 10 girls) were admitted and tested for CMV infection. Six patients (28.6%) were positive for CMV IgM; these were also positive for CMV IgG, CMV PCR, and urine culture, and 4 were also positive for CMV pp65 Ag. The median platelet count at admission was 6,500/µL (range, 2,000-105,000/µL). One patient (16.7%) was diagnosed with Evans syndrome and had calcifications on brain MRI. One patient had unilateral sensorineural hearing loss.
Thrombocytopenia can be the main clinical manifestation of otherwise asymptomatic CMV infection after the neonatal period, and close follow-up of neurodevelopmental sequelae is needed.
Keywords Thrombocytopenia, Cytomegalovirus, Infant
Korean J Hematol 2010; 45(1): 29-35
Published online March 31, 2010 https://doi.org/10.5045/kjh.2010.45.1.29
Copyright © The Korean Society of Hematology.
Joon-Won Kang1, Gee-Na Kim1, Sun-Young Kim2*, Hee-Jin Kim3, Eun-Sil Park4, Jae-Young Kim1, and Young-Ho Lee2
1Department of Pediatrics, The Chungnam National University College of Medicine, Daejeon, Korea.
2Department of Pediatrics, School of Medicine, Hanyang University Medical Center, Seoul, Korea.
3Department of Laboratory Medicine & Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
4Department of Pediatrics, Gyeongsang National University School of Medicine, Jinju, Korea.
Correspondence to: Correspondence to Sun-Young Kim, M.D. Department of Pediatrics, School of Medicine, Hanyang University Medical Center, 17 Haengdang-dong, Seongdong-gu, Seoul 133-792, Korea. Tel: +82-2-2290-9787, Fax: +82-2-2297-2380, nel1205@hanmail.net
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Up to 90% of neonates with congenital or perinatal cytomegalovirus (CMV) infection are asymptomatic, and little is known about CMV-associated thrombocytopenia after the neonatal period. We investigated the clinical findings of a series of infants diagnosed with CMV infection and thrombocytopenia.
From July 2005 to July 2008, infants aged younger than 6 months with thrombocytopenia were screened for CMV infection, using CMV IgM. Those who were positive for CMV IgM were then tested for CMV IgG via polymerase chain reaction (PCR) for CMV and CMV pp65 Ag and urine culture. Brain magnetic resonance imaging (MRI) and otologic and ophthalmologic evaluations were also performed.
Twenty-one patients aged between 1 and 6 months (11 boys and 10 girls) were admitted and tested for CMV infection. Six patients (28.6%) were positive for CMV IgM; these were also positive for CMV IgG, CMV PCR, and urine culture, and 4 were also positive for CMV pp65 Ag. The median platelet count at admission was 6,500/µL (range, 2,000-105,000/µL). One patient (16.7%) was diagnosed with Evans syndrome and had calcifications on brain MRI. One patient had unilateral sensorineural hearing loss.
Thrombocytopenia can be the main clinical manifestation of otherwise asymptomatic CMV infection after the neonatal period, and close follow-up of neurodevelopmental sequelae is needed.
Keywords: Thrombocytopenia, Cytomegalovirus, Infant
Patient 1 shows normal auditory brainstem response (ABR) on the right side (up to 25 dB) and minimal response on the left side.
Brain MRI of Patient 2 shows multiple small nodular T1-high and gradient echo-dark signal intensity lesions in the right occipital lobe (arrow). This finding is compatible with a calcified inflammatory granuloma as a sequela of previous CMV infection. Also note the subdural effusion and right frontotemporal convexity (arrowheads).
Table 1 . Comparisons of patients with thrombocytopenia according to CMV status..
Abbreviations: CMV, cytomegalovirus; GA, gestational age; HC, head circumference; Ht, height; WBC, white blood cell; Hb, hemoglobin; PLT, platelet..
Table 2 . Summary of test results in patients with CMV infection in infancy..
Abbreviations: PLT, platelet; AST, aspartate transaminase; ALT, alanine transaminase; D/ID, direct/indirect; CMV, cytomegalovirus; PCR, polymerase chain reaction..
Table 3 . Clinical manifestations of the patients..
Abbreviation: IVIG, intravenous immune globulin..
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Patient 1 shows normal auditory brainstem response (ABR) on the right side (up to 25 dB) and minimal response on the left side.
|@|~(^,^)~|@|Brain MRI of Patient 2 shows multiple small nodular T1-high and gradient echo-dark signal intensity lesions in the right occipital lobe (arrow). This finding is compatible with a calcified inflammatory granuloma as a sequela of previous CMV infection. Also note the subdural effusion and right frontotemporal convexity (arrowheads).
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