title: Acute renal failure in a child with thrombocytopenic purpura caused by acute Epstein-Barr virus infection after treatment with anti-D immunoglobulin.
abstract: Immune thrombocytopenia (ITP) in children is usually a benign, self-limiting disorder. An acute Epstein-Barr virus (EBV) infection usually causes atypical lymphocytosis and mild decrease in platelets. Severe thrombocytopenia is an extremely rare complication. Anti-D immunoglobulin has been used for treatment of ITP in Rh(D)-positive nonsplenectomized patients. Severe hemolysis and acute renal failure are extremely rare complications that may be aggravated by the presence of an acute EBV infection. It is believed that anti-D immunoglobulin triggers an unusual virus-induced immune response causing hemolysis. We present a 4-year-old girl with ITP caused by an acute EBV infection that developed acute kidney injury following treatment with anti-D immunoglobulin. The patient recovered completely from thrombocytopenia and renal dysfunction. Intravascular hemolysis and acute kidney injury are consistent with anti-D immunoglobulin mechanism of action. Pediatric patients treated with anti-D immunoglobulin for ITP should be closely monitored for signs and symptoms of hemolysis that may be aggravated by the presence of EBV infection leading to impaired renal function.
authors.affiliation: Second Department of Pediatrics, Athens University, Greece. lydiakossiva@hotmail.com
authors.forename: Lydia
authors.initials: L
authors.lastname: Kossiva
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Kyriakou
authors.forename: Andromachi
authors.initials: A
authors.lastname: Mitsioni
authors.forename: Anastasia
authors.initials: A
authors.lastname: Garoufi
mesh_terms: D058186:Acute Kidney Injury / Q000188:drug therapy / Q000209:etiology*; D000914:Antibodies, Viral / Q000097:blood; D002675:Child, Preschool; D003937:Diagnosis, Differential; D020031:Epstein-Barr Virus Infections / Q000097:blood / Q000150:complications*; D005260:Female; D005440:Fluid Therapy; D005665:Furosemide / Q000627:therapeutic use; D006461:Hemolysis / Q000276:immunology; D006463:Hemolytic-Uremic Syndrome / Q000175:diagnosis; D004854:Herpesvirus 4, Human / Q000276:immunology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D007167:Immunotherapy; D007262:Infusions, Intravenous; D007518:Isoantibodies / Q000009:adverse effects*; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000209:etiology* / Q000628:therapy; D018029:Rho(D) Immune Globulin
chemical_list: D000914:Antibodies, Viral; D007075:Immunoglobulin M; D007518:Isoantibodies; C061961:RHO(D) antibody; D018029:Rho(D) Immune Globulin; D005665:Furosemide