European Journal of Biomedical and Pharmaceutical Sciences

CYTOMEGALOVIRUS-ASSOCIATED MULTIFOCAL ARTERIAL THROMBOEMBOLISM IN AN IMMUNOCOMPETENT PATIENT: A CASE REPORT AND REVIEW OF THE LITERATURE

Youssef Aadi*, A’mr Nachite, Youssef Sefsafi, Yassine Benaissi, Ahmed Reggad, Khalid Ennibi

ABSTRACT

Introduction: Arterial thromboembolic complications of cytomegalovirus (CMV) infection are exceedingly rare, accounting for fewer than five of the ~113 cases documented in the world literature. We report an extensive case of CMV-associated multifocal arterial thromboembolism combined with CMV encephalitis in an immunocompetent patient. Case Presentation: A 46-year-old woman with insulin-treated type 2 diabetes (HbA1c 7.6%) presented with sequential thromboses of the left anterior descending coronary artery (03/01/2017), both renal arteries, the splenic, left iliac, and left popliteal arteries, a right sylvian ischemic stroke, and periventricular white matter changes consistent with CMV encephalitis. CMV IgM and IgG were positive with a plasma viral load of 4.01 log copies/mL. Concurrent bacteraemia was ruled out, and infective endocarditis was formally excluded by Modified Duke's criteria. Skin biopsy demonstrated leukocytoclastic vasculitis. Treatment included renal-function-adapted intravenous ganciclovir for six weeks, corticosteroids, anticoagulation, and clopidogrel. Follow-up at six months showed renal stabilization (creatinine 21 mg/L) and recovery of left ventricular ejection fraction from 40% to 54%. Conclusion: This case illustrates CMV's capacity to induce severe, multifocal arterial thromboembolism in immunocompetent patients. CMV serology and PCR should be systematically included in the workup of any unexplained febrile arterial thrombosis.

Keywords: cytomegalovirus; arterial thrombosis; encephalitis; thromboinflammation; immunocompetent; ganciclovir.