Cytomegalovirus-associated multifocal arterial thromboembolism in an immunocompetent patient: A case report and review of the literature

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%.