Biphasic Clinical Course of Pediatric Cytomegalovirus‐Associated Immune Thrombocytopenia: Early Poor Treatment Response but Favorable Long‐Term Outcomes
Oded Gilad, Ohad Atia, Osama Tanous, Dafna Brik Simon, Michal Dvori, Miriam Cohen, Tracie A. Goldberg, Efraim Bilavsky, Joanne Yacobovich, Orna Steinberg‐ShemerABSTRACT
Background
Cytomegalovirus (CMV) is a recognized trigger of immune thrombocytopenia (ITP); however, its incidence and impact on disease course in children remain controversial. Therefore, we aimed to characterize the clinical course of pediatric patients with CMV‐associated ITP.
Procedures
We conducted a single‐center retrospective cohort study of children with ITP, analyzing clinical and laboratory characteristics, treatment, and outcomes in CMV‐positive (CMV pos ) and CMV‐negative (CMV neg ) patients. Univariable and multivariable logistic regression analyses were performed to evaluate the association between CMV status and remission.
Results
Of 444 children with ITP, 25 (5.6%) were CMV pos . At diagnosis, CMV pos patients had significantly lower median platelet counts (5 × 10 3 (interquartile range [IQR] (3–9)) vs. 11 × 10 3 (IQR 5–24)/µL, p = 0.01), hemoglobin levels, absolute neutrophil counts, and higher rates of transaminase elevation; nonetheless, bleeding severity was similar. CMV pos patients more frequently received multiple treatment courses at diagnosis (52.2% vs. 17.8%, p < 0.001). However, during follow‐up at 3–12 months from diagnosis, only 8% of CMV pos patients received treatment as compared with 30.6% of CMV neg patients ( p = 0.01), whereas at 12 months remission rates were significantly higher among CMV pos patients (84% vs. 59.6%, p = 0.018). Only one CMV pos patient received antiviral therapy. In univariable and multivariable logistic regression analyses, CMV positivity was independently associated with 12‐month ITP remission (odds ratio [OR] 3.6, 95% confidence interval [CI] 1.34–12.54 and OR 3.78, 95% CI 1.0004–20.16, respectively).
Conclusions
CMV‐associated ITP is uncommon and follows a characteristic clinical course, marked by early poor treatment response followed by favorable long‐term outcomes. Identification of CMV in pediatric ITP patients provides important prognostic information regarding disease trajectory.