Coombs-negative severe haemolytic anaemia in an immunocompetent adult following cytomegalovirus infection
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Severe haemolysis is a rare, but potentially life-threatening, complication of cytomegalovirus (CMV) infection in immunocompetent adults. Treatment with steroids or immunoglobulins, or even splenectomy, may be justified when an autoimmune mechanism can be identified as the cause of the anaemia. Described here is the case of a previously healthy patient who presented with severe haemolytic anaemia following CMV infection. The patient’s haemoglobin level fell to 5.1 g/dl while extensive testing for an autoimmune mechanism remained negative. The patient made a slow but full recovery without additional medication or blood transfusions. This case demonstrates that severe haemolytic anaemia following CMV infection is possible even when presently available tests fail to show autoimmune positivity. In immunocompetent subjects a wait and see policy, with supportive care when necessary, is likely to be justified.
KeywordsParoxysmal Nocturnal Haemoglobinuria Autoimmune Mechanism Cold Agglutinin Direct Antiglobulin Test Immunocompetent Adult
- 1.Crumpacker CS (2000) Cytomegalovirus. In: Mandell G, Douglas R, Bennet J, Dolin R (eds) Principles and practice of infectious diseases. Churchill Livingstone, Philadelphia, pp 1586–1599Google Scholar
- 4.Kelly WN (1989) Textbook of internal medicine. Lippincott, Philadelphia, pp 1386–1370Google Scholar
- 5.Schreiber A, Gill FM, Manno CS (1993) Autoimmune hemolytic anemia. In: Nathan D, Oski F (eds) Hematology of infancy and childhood. Saunders, Philadelphia, pp 496–510Google Scholar
- 9.Horwitz CA, Henle W, Henle G, Snover D, Rudnick H, Balfour HH Jr, Mazur MH, Watson R, Schwartz B, Muller N (1986) Clinical and laboratory evaluation of cytomegalovirus-induced mononucleosis in previously healthy individuals. Report of 82 cases. Medicine (Baltimore) 65:124–134Google Scholar