Nunes Silva Francisca, Batista Rosa Cláudia, Vasconcelos Bárbara, Teixeira de Jesus Catarina, Gonçalves Cátia, Gonçalves Rocha Carla, Fragoeiro Helena, Catanho João, Valladares Roberta, Freitas Sérgio
General and Family Medicine, Câmara de Lobos Health Center, Serviço de Saúde da Região Autónoma da Madeira, Entidade Pública Empresarial da Região Autónoma da Madeira (SESARAM, EPERAM), Câmara de Lobos, PRT.
General and Family Medicine, Caniço Health Center, Serviço de Saúde da Região Autónoma da Madeira, Entidade Pública Empresarial da Região Autónoma da Madeira (SESARAM, EPERAM), Santa Cruz, PRT.
Cureus. 2024 Dec 8;16(12):e75334. doi: 10.7759/cureus.75334. eCollection 2024 Dec.
Immune thrombocytopenic purpura (ITP) is an autoimmune condition characterized by a reduced platelet count due to enhanced peripheral destruction and impaired platelet production. While thrombocytopenia is a well-documented complication of various viral infections, cytomegalovirus (CMV), a member of the Herpesviridae family, is primarily associated with infections in immunocompromised patients and is rarely implicated in causing severe thrombocytopenia in immunocompetent patients. This article aims to highlight the importance of considering CMV as a significant etiological factor in ITP, particularly in cases of asymptomatic thrombocytopenia. A 34-year-old male presented to the emergency department with a one-week history of progressively worsening erythematous macules on the lower extremities, extending proximally, accompanied by spontaneous ecchymoses, ulcerative and hemorrhagic aphthous lesions in the oral cavity and recurrent episodes of epistaxis. Physical examination revealed petechiae on the ear pavilions, face, trunk, back, upper limbs, abdomen and lower limbs. Intraorally, multiple ulcers and violaceous lesions were observed on the buccal mucosa and tonsillar regions. Additionally, the patient exhibited a localized area of ecchymosis with a central crusted lesion on the right lower leg. Serologic testing for CMV was positive and targeted antiviral therapy was initiated. CMV infection can lead to severe thrombocytopenia in otherwise healthy adults, despite diagnostic challenges. These challenges arise due to the low incidence of severe CMV disease, its diverse clinical manifestations, and its ability to mimic symptoms of other common illnesses. In cases of ITP that resist standard treatments, antiviral therapy may be necessary and should be promptly initiated if CMV infection is confirmed. CMV infection should be included in the differential diagnosis for severe thrombocytopenia in healthy adults, especially following a recent viral infection.
免疫性血小板减少性紫癜（ITP）是一种自身免疫性疾病，其特征是由于外周破坏增强和血小板生成受损导致血小板计数减少。虽然血小板减少是各种病毒感染的一个有充分记录的并发症，但巨细胞病毒（CMV）作为疱疹病毒科的一员，主要与免疫功能低下患者的感染有关，很少被认为会在免疫功能正常的患者中导致严重血小板减少。本文旨在强调将CMV视为ITP的一个重要病因的重要性，特别是在无症状血小板减少的病例中。一名34岁男性因下肢进行性加重的红斑性斑疹1周病史就诊于急诊科，皮疹向近端扩展，伴有自发性瘀斑、口腔溃疡性和出血性口疮性病变以及反复鼻出血。体格检查发现耳廓、面部、躯干、背部、上肢、腹部和下肢有瘀点。口腔内，颊黏膜和扁桃体区域观察到多个溃疡和紫红色病变。此外，患者右小腿有一个局部瘀斑区域，中央有结痂病变。CMV血清学检测呈阳性，并开始进行靶向抗病毒治疗。CMV感染可导致原本健康的成年人出现严重血小板减少，尽管存在诊断挑战。这些挑战是由于严重CMV疾病的发病率低、其多样的临床表现以及它模仿其他常见疾病症状的能力所致。在抵抗标准治疗的ITP病例中，抗病毒治疗可能是必要的，如果确诊为CMV感染，应立即开始治疗。CMV感染应纳入健康成年人严重血小板减少的鉴别诊断中，尤其是在近期病毒感染之后。
