عوامل خطر آمبولی ترومبوز وریدی در طی عفونت سیتومگالوویروس در افراد دارای ایمنی بدن Risk factors of venous thrombo-embolism during cytomegalovirus infection in immunocompetent individuals. A systematic review

Introduction Despite being one of the most widespread infections in the world, most of the effects and complications of cytomegalovirus (CMV) infection are still unknown [1]. Severe complications, such as pulmonary thromboembolism, in immunocompetent patients seem to be more frequent than thought [2]. However, pharmacological treatment of this infection is only available for immunocompromised patients, based on cost-effectiveness and the high prevalence of adverse effects in immunocompetent patients. CMV infection is suspected to be a cause of venous thrombo-embolism (VTE) since 1974, when Vorlicky et al. hypothesized the connection existing between them [3], starting a series of study that brought us to knowledge of the connection between CMV infection and atherosclerosis. On the other hand, there are no certainties about risk factors or about which people most likely to develop a CMV-related VTE. The aim of this systematic review was to identify potential risk factors of CMV-related thrombosis, and to evaluate whether and when anticoagulant and antiviral drugs need to be used. Case repor A 35-year-old woman came to our attention complaining of fever, chills, and night sweats which had started a week before. She also complained of asthenia. She came back from her honeymoon, during which she visited Australia, 15 days before the medical examination. She had a similar symptomatology during travel, for which she was treated with NSAIDs with some relief. She had been taking a daily oestroprogestive birth control pill for almost 6 months. The clinical examination only revealed a spread lymphadenopathy, involving cervical, right axillary, and right inguinal nodes. At admission, laboratory findings were of normal leukocyte count, normal alanine and aspartate amino-transferases (ALT and AST), and normal C reactive protein (CRP). CMV-IgG were positive, while IgM were negative, highlighting a previous infection. On a serological basis, we excluded HIV infection, EBV infection, and Brucella melitensis infection. We performed an intradermal reaction test with purified protein derivative (PPD), which resulted negative after 48 h. An abdominal ultrasound (US) identified a mild splenomegaly and a pericardial effusion, confirmed by an echocardiography (the patient had a familial history of recurrent pericarditis).