Coombs-Negative Severe Hemolytic Anemia and Possible Autoimmune Disease in an Adult Following Cytomegalovirus Infection

Abstract

Hemolysis is a quite uncommon complication of Cytomegalovirus (CMV) infection, which could rarely present with severe manifestations. Diagnosis is usually based on exclusion of other causes of hemolytic anemia, history of CMV infection, accompanied by positive serological tests and positive direct Coombs (DAT) Test, evidence indicative of post-infection autoimmune response. Although most cases present no symptoms, there have been reports of severe post CMV infection hemolysis requiring treatment with steroids, immunoglobulin or even splenectomy. It is herby described the case of a 19-year-old immune competent woman, who presented with severe hemolytic anemia following primary CMV infection. The patient’s Hemoglobin (Hb) level was 5.8 g/dl on the day of admission. Extensive laboratory testing for causes of anemia, active infections, systemic diseases and autoimmunity showed positive Antinuclear Antibodies and positive CMV IgM and IgG Antibodies. Although direct Coombs Test were persistently negative, post infection autoimmunity was suspected and after steroid treatment was initiated, the patient achieved full recovery. In immune competent individuals suffering from post CMV infection hemolysis a stay and watch policy could be employed. However, as far as an autoimmune mechanism is suspected the patient is eligible for steroid treatment.