Taglietti et al. Journal of Medical Case Reports 2010, 4:334 http://www.jmedicalcasereports.com/content/4/1/334 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Hemolytic anemia due to acute cytomegalovirus infection in an immunocompetent adult: a case report and review of the literature Fabrizio Taglietti*, Cecilia M Drapeau, Elisabetta Grilli, Alessandro Capone, Pasquale Noto, Simone Topino, Nicola Petrosillo Abstract Introduction: Cytomegalovirus is a common virus responsible for a wide range of clinical manifestations. Hemolysis is a rare but potentially life-threatening complication of cytomegalovirus infection, described mostly in immunocompromised patients, the pathogenesis of which is still unclear. We performed a review of the literature regarding cases of hemolytic anemia during acute cytomegalovirus infec- tion in apparently immunocompetent individuals. We searched for relevant articles in PubMed for the period of 1980 through 2008. Case presentation: We describe a case of Coombs-negative hemolytic anemia in a 44-year-old Caucasian immunocompetent man with acute cytomegalovirus infection. Conclusion: Clinicians should consider cytomegalovirus infection in the differential diagnosis of hemolytic anemia in immunocompetent adults. Possible therapeutic options include antiviral therapy and steroids, although the best treatment strategy is still controversial. Introduction Cytomegalovirus (CMV) is a common viral agent responsible for a wide range of clinical manifestations that vary according to the immunologic status of the patient. In the immunocompetent adult patient, primary CMV infection is generally asymptomatic or occurs as a mononucleosis-like self-limited syndrome. In immuno- compromised patients, CMV infection can lead to severe clinical manifestations related to direct viral cytotoxic effect on specific organs and tissues (gastrointestinal tract, central nervous system, retina, respiratory tract, and hematopoietic system). In patients with transplants, CMV is responsible for allograft rejection and opportu- nistic infection. Finally, CMV infection has been also associated with other manifestations, including hemoly- tic anemia [1-3]. Severe hemolysis is a rare but potentially life-threatening complication of CMV infection described mostly in * Correspondence: taglietti.f@gmail.com 2ndInfectious Diseases Division, National Institute for Infectious Diseases “L. Spallanzani”, Via Portuense, 292-00149 Rome, Italy immunocompromised adults [1-3] and children [4]. The pathogenesis of hemolytic anemia during CMV infection is still unclear, although it has been hypothesized to be the result of immunologic activation [1-3]. Hemolytic anemia is rarely described in immunocompetent adults [1-3,5-8]. We describe a Coombs-negative hemolytic anemia in an adult immunocompetent patient with acute CMV infection. Case presentation A 44-year-old Caucasian man, without any relevant past medical history, was admitted to our Infectious Diseases Hospital because of a 30-day history of fever and pro- gressive asthenia. Fifteen days earlier, the patient was hospitalized in an Emergency Medical Department, where acute CMV infection was diagnosed (positive CMV IgM, negative CMV IgG, CMV viremia, 12,698 copies/mL). Other tests showed alanine aminotransfer- ase (ALT), 47 U/L (normal value, < 40); aspartate ami- notransferase (AST), 71 U/L (n.v., < 40); alkaline phosphatase (ALP), 304 U/L (n.v., < 130 U/L); and lac- tate dehydrogenase (LDH), 600 U/L (n.v., < 500 U/L). © 2010 Taglietti et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.