Hemolitic anemia in a previously healthy pregnant woman with a primary human cytomegalovirus infection

BRIEF INTRODUCTION Primary Human Cytomegalovirus (HCMV) infection in immunocompetent adults is often asymptomatic. While hemolytic anemia is commonly seen in infants, it is an infrequent complication in healthy adults. MATERIALS AND METHODS A pregnant woman experienced an hemolytic anemia following a CMV primary infection. CLINICAL CASES OR SUMMARY RESULTS An healthy 20-year-old Italian pregnant woman in the 27th week of gestation referred to our hospital with fever and asthenia; no other signs or symptoms were present. Laboratory results showed haemoglobin 7.8 g/dl, reticulocytes 6.3%, white blood cells count 10400/mmc (55% lymphocytes), alanine aminotransferase 59 U/L, aspartate aminotransferase 52 U/L, haptoglobin <0.05g/l. Direct and indirect bilirubin were in range. Direct and indirect Coombs test, antiphospholipid antibodies, anticardiolipin antibodies and antinuclear antibodies were negative. A very small amount of cold agglutinins were detected. Serologic test for HCMV resulted positive for both IgG and IgM. HCMVDNA blood level of 33730 genomes/ml was detected by polymerase chain reaction (PCR). Diagnosis of hemolytic anemia and HCMV primary infection was established. Prednisone treatment was started and complete resolution of fever and asthenia were observed; haptoglobin values quickly became normal. No foetal anomalies were found in sonographic examinations. An apparently healthy 3.3 kg female infant was delivered at the 37th week with HCMV-DNA detection in blood and urine specimens. No clinical manifestations of congenital infection to date (six months of life) were observed. No antiviral therapy was administered to the newborn infant. CONCLUSIONS Once a diagnosis of primary HCMV infection was made during pregnancy, clinical attention should be addressed to the mother’s health in order to avoid maternal and foetal complications.