CMV Mononükleozis, Direkt Coombs Testi (-) Hemolitik Anemi ve Trombositopeni Birlikteliği

Sitomegalovirüs (CMV) hastanın immünolojik durumuna göre değişen çeşitli klinik belirtilerden sorumlu olan bir viral ajandır. Bağışıklık sistemi normal olan hastalarda, primer CMV enfeksiyonu genellikle asemptomatiktir veya kendini sınırlayan mononükleozis benzeri bir sendrom olarak gösterebilir. Bu yazıda; CMV mononükleozis, direkt Coombs testi (-) hemolitik anemi ve trombositopenisi olan iki buçuk aylık bir kız hasta sunulmuştur. Huzursuzluk ve öksürük nedeniyle getirilen hastanın solukluğu, hepatosplenomegalisi, büyüme ve gelişme geriliği vardı. Hastada lökositoz, anemi, trombositopeni, karaciğer fonksiyon bozukluğu, periferik yaymada CMV mononükleozisi ve retikülositozisi tespit edildi. CMV IgM (+), CMV PCR (+), direkt Coombs (-), haptoglobin düşük olarak bulundu. Hastaya her hangi bir tedavi verilmedi. Klinik ve laboratuvar olarak tamamen düzeldi ve herhangi bir komplikasyon gözlenmedi. Sonuç olarak; hemolitik anemi ve trombositopeni ayırıcı tanısında sitomegalovirüs enfeksiyonu da düşünülmeli, bağışıklığı yeterli olan kişilerde gerektiğinde destekleyici bakım ile tedavisiz izlem politikası uygulanmalıdır.

Direct Coombs Test, and Thrombocytopenia Simultaneous CMV Mononucleosis, Hemolytic Anemia with Negative

Cytomegalovirus (CMV) is a viral agent that can cause various clinical signs according to the patient's immune status. Primary CMV infection is usually asymptomatic in patients with a normal immune system and can lead to a self-limited, mononucleosis-like syndrome. We present a two and a half months old female with CMV mononucleosis, negative direct Coombs test, hemolytic anemia and thrombocytopenia. The patient presented with restlessness and cough and the examination revealed paleness, hepatosplenomegaly, and retarded growth and development. Laboratory tests showed leukocytosis, anemia, thrombocytopenia, and liver function disorder while peripheral smear showed CMV mononucleosis and reticulocytosis. Other results were CMV IgM (+), CMV PCR (+), direct Coombs (-), and haptoglobin level low. No treatment was given. The patient made a full clinical and laboratory recovery with no complications. In conclusion, cytomegalovirus infection should be considered in the differential diagnosis of hemolytic anemia and thrombocytopenia. Supportive care with untreated attitude is adequate for patients with normal immunity.

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