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

Abstract

Abstract Background: Immune thrombocytopenia (ITP) is an acquired disorder characterised by low platelet counts due to immune-mediated destruction and impaired platelet production. 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 RT, the patient was diagnosed with primary CMV infection. After treatment initiation for primary CMV infection, the patient developed isolated thrombocytopenia. Excluding other diseases or drugs that might cause thrombocytopenia, the patient was finally diagnosed with ITP, administered prednisolone (PSL),and started on Helicobacter pylori (H. pylori) eradication therapy. Tapering the PSL dose was difficult. However, thrombopoietin receptor agonists (TPO-RAs) were effective. Conclusions: In this case, the patient was diagnosed with ITP, and other causes of thrombocytopenia were successfully ruled out, despite the many causes of thrombocytopenia after RT. We showed 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.