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Case Reports
. 2023 Nov 13;24(1):336.
doi: 10.1186/s12882-023-03385-x.

Immune thrombocytopenia secondary to primary cytomegalovirus infection after renal transplantation treated with a thrombopoietin receptor agonist: a case report

Tomohiro Takehara  1 , Hayato Nishida  2 , Kazunobu Ichikawa  3 , Yuka Hosokawa  4 , Takaaki Nawano  3 , Satoshi Takai  2 , Hiroki Fukuhara  2 , Masahito Himuro  4 , Norihiko Tsuchiya  2 , Masafumi Watanabe  3
Affiliations
Case Reports

Immune thrombocytopenia secondary to primary cytomegalovirus infection after renal transplantation treated with a thrombopoietin receptor agonist: a case report

Tomohiro Takehara et al. BMC Nephrol. .

Abstract

Background: Immune thrombocytopenia (ITP) is an acquired disorder characterised by a low platelet count due to immune-mediated destruction and impaired platelet production. Here we report a rare case of primary cytomegalovirus (CMV) infection followed by thrombocytopenia after renal transplantation (RT).

Case presentation: A 24-year-old male patient with end-stage kidney disease secondary to hereditary focal segmental glomerulosclerosis was treated with peritoneal dialysis and received ABO-compatible living-related RT from his aunt. Nine months after the RT, the patient was diagnosed with primary CMV infection. After initiating treatment for primary CMV infection, the patient developed thrombocytopenia. After excluding other diseases or drugs that may cause thrombocytopenia, the patient was finally diagnosed with ITP, administered prednisolone (PSL), and started on Helicobacter pylori eradication therapy. Tapering the PSL dose was difficult, but thrombopoietin receptor agonists (TPO-RAs) were effective.

Conclusions: In this case, the patient was diagnosed with ITP, and other causes of thrombocytopenia after RT were successfully ruled out. This case report demonstrates that RT recipients can develop ITP after CMV infection, and, in such cases, TPO-RAs may be an attractive option as a second-line therapy.

Keywords: Cytomegalovirus infection; Immune thrombocytopenia; Post-transplant thrombocytopenia; Renal transplantation.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Computed tomography revealed no pneumonia (a), intestinal oedema (b), hepatomegaly (c), or lymphadenopathy (a-c)
Fig. 2
Fig. 2
The patient’s clinical course. AMPC, amoxicillin; CAM, clarithromycin; CMV ag, cytomegalovirus antigenemia; EVR, everolimus; GCV, ganciclovir; H. pylori, Helicobacter pylori; MMF, mycophenolate mofetil; mPSL, methylprednisolone; PPI, proton pump inhibitor; PSL, prednisolone; TAC, tacrolimus; VGCV, valganciclovir; W, weeks after first admission
See this image and copyright information in PMC

References

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