PMC4630589_01
Platelet count before and after treatment. Graph representing the trend of platelet count from the time of admission to the post treatment period with valgancyclovir, romiplostim, and IVIG.
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F1
On admission, the patient was found to have platelet count of 1.0 x 109/L (Figure 1).The normal range for platelets in healthy Caucasians is 150,000-400,000/mm3 (a cubic millimeter equals a microliter), or 150-400 x 109/L. The patient was discharged with a platelet count of 49 x 109/L (Figure 1).
Viral load before and after treatment. Viral load in copies/MI for Cytomegalovirus (CMV) measured at admission, post treatment with valgancyclovir and during follow-up.
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F2
An infectious work up was performed, and results were all negative except by PCR for CMV-DNA that showed CMV IgM more than fourfold, a viral load of 46,881 copies/MI (Figure 2). Per Infectious Disease and Hematology-Oncology medical team recommendations, a combination of valgancyclovir (900 mg PO BID) and romiplostin (Nplate  1 mug/kg SC/week) was started, causing a significant drop in viral load (Figure 2). One month later, platelet count improved to 228 x 109/L, and CMV viral load dropped to <200 copies/MI and asymptomatic (Figure 2).