Overcoming Cytomegalovirus Induced Immune Thrombocytopenia in Immunocompetent Adults – A Case of Antiviral Therapy Efficacy

31 March 2025 : Case report USA

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Unusual setting of medical care, Unexpected drug reaction, Rare disease

Sujatha Baddam^{ABCDEFG 1*}, Mrudula Thiriveedi^{E 2}, Siddharth Patel

^{E 2}

DOI: 10.12659/AJCR.947070

Am J Case Rep 2025; 26:e947070

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Table 1. Comprehensive blood count, metabolic panel, and additional laboratory parameters.

Description	Result	Reference range	Units

WBC count	14.43	4.10–12.20	10/uL
RBC count	3.66	4.40–5.50	10/uL
Hemoglobin	11.2	12.2–16.7	g/dL
Hematocrit	32	38.2–49.2	%
MCV	81.9	77.8–97.4	fL
MCH	27.3	25.9–32.7	Pg
MCHC	33.1	31.5–35.4	g/dL
RDW	14.2	12.3–15.9	%
Platelet count	4	153–369	10/uL
Immature granulocytes	3.9 H	0.0–0.3	%
Nucleated RBCs	0.2		%
Absolute neutrophil count	4.37	1.50–7.50	10/uL
Absolute lymphocyte count	8.25	1.10–3.40	10/uL
Absolute monocyte count	1.02	0.30–1.10	10/uL
Absolute eosinophil count	0.39	0.00–0.50	10/uL
Absolute basophil count	0.02	0.00–0.30	10/uL
Band neutrophil	0	0–5	%
Atypical lymphocytes	4.5	0–6	%
Tear drop cells	Occasional
Platelet morphology	Normal
Diff type	Manual

Sodium	131	(133–145)	mmol/L
Potassium	3.4	(3.5–5.0)	mmol/L
Chloride	98	(96–108)	mmol/L
CO2	23	(22–29)	mmol/L
BUN	8	(6–20)	mg/dL
Creatinine	1.4	(0.7–1.2)	mg/dL
Glucose	103	(70–100)	mg/dL
Calcium	8.4	(8.6–10.0)	mg/dL
Anion gap	10	(7–17)
Calc osmolality	261		mosm/kg
BUN/CREAT	6	(5–28)
GFR African American	>60	(>60)	GFR unit
GFR non-African American	>60	(>60)	GFR unit
Bilirubin, total	0.8	(<1.0)	mg/dL
Total protein	6.6	(6.4–8.3)	g/dL
Albumin	3.4	(3.5–5.2)	g/dL
Alk phos	52	(39–117)	U/L
ALT	49	(<42)	U/L
AST	49	(<39)	U/L

D-dimer	1.51	0.49	ug/mL
Fibrinogen level, blood	477	209–478	mg/dL
Protime	15.5	12.5–15.5	s
International normalized ratio	1.2
Partial thromboplastin time	36	27–39	s
Thrombin time	15.4	13.8–19.6	s
Adamts13 activity assay	96	≥70
Dat, broad spectrum Coombs serum	Negative	Negative
Cold antibody titer	1: 08
C-reactive protein	4.8	<0.5	mg/dL
Sed. rate, erythrocytes ESR	12	0–15	mm/h

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