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

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 (...

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Bibliographic Details
Published in:BMC nephrology 2023-11, Vol.24 (1), p.1-336, Article 336
Main Authors: Takehara, Tomohiro, Nishida, Hayato, Ichikawa, Kazunobu, Hosokawa, Yuka, Nawano, Takaaki, Takai, Satoshi, Fukuhara, Hiroki, Himuro, Masahito, Tsuchiya, Norihiko, Watanabe, Masafumi
Format: Article
Language:English
Subjects:
ABO system
Agonists
Analysis
Antigens
Blood
Blood platelets
Care and treatment
Chronic kidney failure
Complications and side effects
Corticosteroids
Creatinine
Cytomegalovirus
Cytomegalovirus infection
Cytomegalovirus infections
Development and progression
Disease susceptibility
Dosage and administration
End-stage renal disease
Epstein-Barr virus
Health aspects
Hematuria
Hemoglobin
Idiopathic thrombocytopenic purpura
Immune thrombocytopenia
Immunoglobulins
Immunosuppressive agents
Infection
Infections
Kidney diseases
Kidney transplantation
Kidney transplants
Kidneys
Leukocytes
Leukopenia
Nephrology
Patients
Peritoneal dialysis
Platelets
Post-transplant thrombocytopenia
Prednisolone
Prevention
Renal transplantation
Risk factors
Steroids
Thrombocytopenia
Thrombopoietin
Transplantation
Viral infections
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Summary: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: Renal transplantation, Immune thrombocytopenia, Cytomegalovirus infection, Post-transplant thrombocytopenia
ISSN:1471-2369
1471-2369
DOI:10.1186/s12882-023-03385-x