title: Cytomegalovirus-associated immune thrombocytopenic purpura after liver transplantation.
abstract: Immune thrombocytopenic purpura (ITP) is a rare complication after liver transplantation. Infection with cytomegalovirus (CMV) is a frequent complication of organ transplantation and may induce autoimmune diseases, such as ITP. We report a case of ITP after primary CMV infection in a 3-year-old boy recipient of living-related orthotopic liver transplantation (OLT). The ITP developed 2 years after OLT in this patient who had received tacrolimus as an immunosuppressive agent, with nadir platelet counts of 5000/mm(3) in 2 weeks. The patient was treated with two courses of intravenous gamma globulin (1 g/kg/day for 2 days) and subsequent oral prednisolone (1.3 mg/kg/day for 2 weeks). He recovered from thrombocytopenia 4 weeks later. An inadequate immunosuppression, as evident by the low serum tacrolimus level (5.8 ng/mL before the episode of ITP) in this patient, may allow the development of ITP after CMV infection.
authors.affiliation: Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
authors.forename: Shu-Hao
authors.initials: SH
authors.lastname: Wei
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Ho
authors.forename: Yen-Hsuan
authors.initials: YH
authors.lastname: Ni
authors.forename: Dong-Tsamn
authors.initials: DT
authors.lastname: Lin
authors.forename: Po-Huang
authors.initials: PH
authors.lastname: Lee
mesh_terms: D001656:Biliary Atresia / Q000601:surgery; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000209:etiology*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D011696:Purpura, Thrombocytopenic / Q000188:drug therapy / Q000821:virology*
chemical_list: D005938:Glucocorticoids; D011239:Prednisolone