Cytomegalovirus-induced Severe Aregenerative Autoimmune Hemolytic Anemia in an Immunocompetent Patient

Abstract

Background:  While cytomegalovirus (CMV) infection is usually benign in immunocompetent adults, it can exceptionally trigger severe hematological autoimmunity. Case Presentation: We report the case of a 41-year-old immunocompetent woman admitted with profound symptomatic anemia (Hb 1.9 g/dL). Laboratory findings showed positive direct antiglobulin test and marked aregenerative anemia. Bone marrow biopsy excluded malignant or aplastic processes. CMV serology confirmed acute primary infection,and the patient was initially treated with red blood cell transfusions associated with antiviral therapy. Corticosteroids were added afterwards. Clinical evolution was favorable, with complete clinical and hematologic recovery. Conclusion: CMV-induced anemia, although exceptional in immunocompetent adults, should be recognized as a potential diagnostic challenge in acute severe anemia. This case highlights the need for greater awareness among clinicians and for future research to establish standardized therapeutic strategies and evaluate the long-term autoimmune implications of CMV infection.