一例因後續感染巨細胞病毒導致難治性的血栓性血小板
減少性紫斑症－病例報告
 
楊佩玉¹　鄭雅綺¹　翁千惠¹　楊玉英^1*　林益卿^2,3*　張舜智^4*

 
一名55歲男性，因身心疾病長期在療養院住院，因護理人員發現全身多處紫斑而至地區醫院求診，實驗室報告顯示嚴重的血小板減少，醫師懷疑可能為血栓性血小板減少性紫斑症(thrombotic thrombocytopenic purpura, TTP)，轉至醫學中心就診。經ADAMTS13活性分析確診為TTP，以血漿置換(therapeutic plasma exchange, TPE)治療。因病人家屬要求，轉至本院就診，入院之初以血漿置換和類固醇治療，幾天後血小板明顯上升，但三週後儘管每天仍進行血漿置換和類固醇治療，病人血小板計數仍持續下降。後續因檢測到巨細胞病毒(CMV)的感染，經抗病毒劑治療後，血小板回升。CMV引起的TTP在文獻上並不多見，在臨床上若治療TTP未達到預期的改善時，可能須考慮是否為CMV感染。
（台灣家醫誌2020; 30: 169-176）DOI: 10.3966/168232812020093003005
 
關鍵詞：血栓性血小板減少性紫斑症、vWF解離酶、治療性血漿置換、巨細胞病毒
 

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¹秀傳紀念醫院檢驗科、⁴腎臟科；²亞洲大學附屬醫院家庭醫學科、³亞洲大學健康產業學系
受理日期：109年3月13日　　修改日期：109年5月11日　　同意刊登：109年5月16日
通訊作者：林益卿　　　　　通訊地址：41354台中市霧峰區福新路222號 亞洲大學附設醫院預防暨社區醫學中心
E-mail: licypy01@gmail.com　*共同通訊作者

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 A Case of Refractory Thrombotic Thrombocytopenic
Purpura Due to Subsequent Infection with CMV:
A Case Report

Pei-Yu Yang¹, Ya-Chi Cheng¹, Chien-Hui Weng¹, Yu-Ying Yang¹, I-Ching Lin^3,4
and Hsun-Chin Chang²

A 55-year-old schizophrenic male nursing home resident was found multiple purpura throughout the body and sent to a regional hospital for treatment.Laboratory data showed severe thrombocytopenia, and TTP was suspected; the patient was then referred to a medical center. TTP was diagnosed by ADAMTS13 activity analysis and treated with plasma exchange. Upon to the request of the patient's family, he was transferred to our hospital for treatment. At the beginning, he was still treated with plasma exchange and steroid. After three weeks of continuous daily plasma exchange and high-dose steroid, his platelet count remained low.During the treatment, an infection with CMV was detected, and platelets recovered after treatment with antiviral agents. CMV-induced TTP is rare in the literature. If the treatment of TTP fails to achieve expected improvement, it may be necessary to consider whether it is a CMV infection.
(Taiwan J Fam Med 2020; 30: 169-176) DOI: 10.3966/168232812020093003005
 
Key words: A disintegrin and metalloproteinase with thrombospondin motifs, 13 (ADAMST13),cytomegalovirus (CMV), therapeutic plasma exchange (TPE),thrombotic thrombocytopenic purpura (TTP)
 

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¹Department of Labortatory, ²Department of Nephrology, Show-Chwan Memorial Hospital; ³Department of Family Medicine, Asia University Hospital, Asia University; ⁴Department of Healthcare Administration, Asia University, Taichung, Taiwan.
Received: March 13 2020; Revised: May 11, 2020; Accepted: May 16, 2020.