Diagnostic Challenges in Pulmonary Embolism in Young Adults: Thrombosis Associated With Cytomegalovirus and Mycoplasma pneumoniae

A 23-year-old man presented with a fever, shaking chills, headaches, nausea, and a dry cough. Investigations showed lymphocytic leukocytosis with atypical lymphocytes in a blood smear. Liver function test results, D-dimer concentrations, and fibrin degradation product concentrations were greatly ele...

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Published inCurēus (Palo Alto, CA) Vol. 14; no. 12; p. e32757
Main Authors Hikichi, Haruka, Hasegawa, Ryo, Saga, Akiko, Saga, Tomoo, Ueki, Shigeharu
Format Journal Article
LanguageEnglish
Published United States Cureus Inc 20.12.2022
Subjects
Abdomen
Anticoagulants
Case reports
Cytomegalovirus
Epstein-Barr virus
Medical diagnosis
Pulmonary embolisms
Young adults
mycoplasma pneumoniae infection
lupus anticoagulant
pulmonary embolism (pe)
cytomegalovirus (cmv)
splenic infarction
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Summary:A 23-year-old man presented with a fever, shaking chills, headaches, nausea, and a dry cough. Investigations showed lymphocytic leukocytosis with atypical lymphocytes in a blood smear. Liver function test results, D-dimer concentrations, and fibrin degradation product concentrations were greatly elevated. Computed tomography of the whole body with contrast showed hepatosplenomegaly with splenic infarction and bilateral pulmonary embolism without deep vein thrombosis. Cytomegalovirus (CMV) immunoglobulin M, and serum CMV pp65 antigenemia were positive, and serum ( ) antibody was also highly positive. These results suggested the diagnosis of co-infection of CMV and complicated by systemic arteriovenous thrombosis, which resulted in pulmonary embolism and splenic infarction. After he started edoxaban tosilate hydrate for the thrombosis, his symptoms resolved in a few days. To the best of our knowledge, this is the first case of co-infection of CMV and leading to pulmonary embolism and splenic infarction.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.32757