Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case report
Background: While petechiae can be a sign of a serious underlying condition, the majority are benign. Frequently, an underlying cause is not identified despite extensive diagnostic testing. Petechiae may be caused by CMV infection which is rarely considered in the differential diagnostic process. Mo...
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Elsevier
2024-12-01
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| Series: | JEM Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773232024000531 |
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| author | Emilie Fraisse Mads Emil Bruusgaard-Mouritsen Rasmus Gregersen |
| author_facet | Emilie Fraisse Mads Emil Bruusgaard-Mouritsen Rasmus Gregersen |
| author_sort | Emilie Fraisse |
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| description | Background: While petechiae can be a sign of a serious underlying condition, the majority are benign. Frequently, an underlying cause is not identified despite extensive diagnostic testing. Petechiae may be caused by CMV infection which is rarely considered in the differential diagnostic process. Most immunocompetent adults with primary CMV infection are asymptomatic or develop a mononucleosis-like syndrome with fever and mild hepatitis. Case report: We report the case of a 30-year-old man who presented to an out-of-hours general physician consult with intermittent fever for three weeks. Examination showed petechiae on the upper extremities. Initial laboratory data revealed lymphocytosis and elevated liver enzyme tests. Further testing showed positive CMV throat swab and CMV/EBV immunoglobulin M and G. His symptoms resolved gradually without any treatment. Why should an emergency physician be aware of this?: This report shows that primary CMV infection can be a cause of petechiae. Emergency physicians should keep in mind that although uncommon, immunocompetent adults can experience acute symptomatic CMV infections characterized by an extended disease course and testing may avoid unnecessary and extensive diagnostic workup and repeated hospital contacts. |
| format | Article |
| id | doaj-art-49429bb020a74eee9a3e419bafd8c792 |
| institution | OA Journals |
| issn | 2773-2320 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JEM Reports |
| spelling | doaj-art-49429bb020a74eee9a3e419bafd8c7922025-08-20T02:07:24ZengElsevierJEM Reports2773-23202024-12-013410012310.1016/j.jemrpt.2024.100123Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case reportEmilie Fraisse0Mads Emil Bruusgaard-Mouritsen1Rasmus Gregersen2Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Corresponding author. Department of Emergency Medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg Hospital, Ebba Lunds Vej 41C, building 67, 2nd floor, 2400 Copenhagen NV, Denmark.Department of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, DenmarkDepartment of Emergency Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DenmarkBackground: While petechiae can be a sign of a serious underlying condition, the majority are benign. Frequently, an underlying cause is not identified despite extensive diagnostic testing. Petechiae may be caused by CMV infection which is rarely considered in the differential diagnostic process. Most immunocompetent adults with primary CMV infection are asymptomatic or develop a mononucleosis-like syndrome with fever and mild hepatitis. Case report: We report the case of a 30-year-old man who presented to an out-of-hours general physician consult with intermittent fever for three weeks. Examination showed petechiae on the upper extremities. Initial laboratory data revealed lymphocytosis and elevated liver enzyme tests. Further testing showed positive CMV throat swab and CMV/EBV immunoglobulin M and G. His symptoms resolved gradually without any treatment. Why should an emergency physician be aware of this?: This report shows that primary CMV infection can be a cause of petechiae. Emergency physicians should keep in mind that although uncommon, immunocompetent adults can experience acute symptomatic CMV infections characterized by an extended disease course and testing may avoid unnecessary and extensive diagnostic workup and repeated hospital contacts.http://www.sciencedirect.com/science/article/pii/S2773232024000531CytomegalovirusImmunocompetentFever of unknown originPetechiae |
| spellingShingle | Emilie Fraisse Mads Emil Bruusgaard-Mouritsen Rasmus Gregersen Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case report JEM Reports Cytomegalovirus Immunocompetent Fever of unknown origin Petechiae |
| title | Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case report |
| title_full | Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case report |
| title_fullStr | Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case report |
| title_full_unstemmed | Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case report |
| title_short | Prolonged fever complicated by petechiae in an immunocompetent adult with primary CMV infection: A case report |
| title_sort | prolonged fever complicated by petechiae in an immunocompetent adult with primary cmv infection a case report |
| topic | Cytomegalovirus Immunocompetent Fever of unknown origin Petechiae |
| url | http://www.sciencedirect.com/science/article/pii/S2773232024000531 |
| work_keys_str_mv | AT emiliefraisse prolongedfevercomplicatedbypetechiaeinanimmunocompetentadultwithprimarycmvinfectionacasereport AT madsemilbruusgaardmouritsen prolongedfevercomplicatedbypetechiaeinanimmunocompetentadultwithprimarycmvinfectionacasereport AT rasmusgregersen prolongedfevercomplicatedbypetechiaeinanimmunocompetentadultwithprimarycmvinfectionacasereport |