Blood Res 2018; 53(2):
Published online June 25, 2018
https://doi.org/10.5045/br.2018.53.2.110
© The Korean Society of Hematology
1Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Korea.
2Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
3Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
4Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea.
5Department of Pediatrics, Fatima Hospital, Daegu, Korea.
Correspondence to : Ye Jee Shim, M.D., Ph.D. Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Dalseong-ro 56, Jung-gu, Daegu 41931, Korea. yejeeshim@dsmc.or.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
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.
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 (
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.
Keywords Cytomegalovirus, Immune thrombocytopenia, Immunocompetent, Ganciclovir, Valganciclovir
Blood Res 2018; 53(2): 110-116
Published online June 25, 2018 https://doi.org/10.5045/br.2018.53.2.110
Copyright © The Korean Society of Hematology.
Min Ji Jin1, Yunkyum Kim1, Eun Mi Choi1, Ye Jee Shim1*, Heung Sik Kim1, Jin Kyung Suh2, Ji Yoon Kim3, Kun Soo Lee3, Sun Young Park4, Jae Min Lee4, and Jeong Ok Hah5
1Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Daegu, Korea.
2Department of Pediatrics, Gachon University Gil Medical Center, Incheon, Korea.
3Department of Pediatrics, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea.
4Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, Korea.
5Department of Pediatrics, Fatima Hospital, Daegu, Korea.
Correspondence to:Ye Jee Shim, M.D., Ph.D. Department of Pediatrics, Keimyung University School of Medicine and Dongsan Medical Center, Dalseong-ro 56, Jung-gu, Daegu 41931, Korea. yejeeshim@dsmc.or.kr
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
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.
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 (
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.
Keywords: Cytomegalovirus, Immune thrombocytopenia, Immunocompetent, Ganciclovir, Valganciclovir
Table 1 .
Abbreviations: CMV, cytomegalovirus; IVIG, intravenous immunoglobulin; PCR, polymerase chain reaction..
Table 2 .
Abbreviations: CMV ITP, immune thrombocytopenia induced by cytomegalovirus; IVIG, intravenous immunoglobulin..
Table 3 .
Abbreviations: CMV, cytomegalovirus; ITP, immune thrombocytopenia..
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