巨细胞病毒再激活继发全血细胞减少。
Pancytopenia secondary to cytomegalovirus reactivation.
作者信息
Tse Justin Ruey, Ng Gan Xon
机构信息
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
出版信息
BMJ Case Rep. 2014 Jan 13;2014:bcr2013201857. doi: 10.1136/bcr-2013-201857.
A 64-year-old woman with a 1-year history of microscopic polyangiitis developed isolated pancytopenia secondary to cytomegalovirus (CMV) reactivation. The patient was originally admitted to the medical service for the management of a rapidly progressing 10 cm ulcer on her left lower extremity. Prior to admission, the patient had been on several immunosuppressive agents for the treatment of microscopic polyangiitis, including prednisone, azathioprine, cyclophosphamide and rituximab. Her hospital course was notable for pancytopenia and after a very thorough diagnostic work-up, the aetiology was found to be secondary to CMV reactivation. This was confirmed by blood analysis that revealed a highly elevated CMV level at 899 100 copies/mL by quantitative PCR. The patient was promptly treated with intravenous ganciclovir for a total course of 14 days before transitioning to an oral regimen. She had a pronounced response to the anti-CMV therapy with complete recovery of her white cell count, haemoglobin and platelet count to baseline.
一名患有显微镜下多血管炎1年的64岁女性，继发于巨细胞病毒（CMV）再激活而出现单纯性全血细胞减少。患者最初因左下肢迅速进展的10厘米溃疡而入住内科治疗。入院前，患者曾使用多种免疫抑制剂治疗显微镜下多血管炎，包括泼尼松、硫唑嘌呤、环磷酰胺和利妥昔单抗。她的住院过程以全血细胞减少为显著特征，经过非常全面的诊断检查后，发现病因是继发于CMV再激活。血液分析证实了这一点，定量PCR显示CMV水平高度升高，达到899 100拷贝/毫升。患者立即接受静脉注射更昔洛韦治疗，疗程共14天，之后转为口服治疗方案。她对抗CMV治疗反应显著，白细胞计数、血红蛋白和血小板计数完全恢复至基线水平。
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