ABSTRACT
A case of severe and irreversible pancytopenia secondary to acute primary cytomegalovirus infection in an immunocompetent woman is described. The patient presented with thrombocytopenia, lymphopenia, anemia, and abnormal liver function tests. Treatment with corticosteroids and intravenous immunoglobulin was ineffective in reconstituting hemopoiesis. The patient developed severe sepsis and eventually expired.
Subject(s)
Cytomegalovirus Infections/complications , Immunocompetence , Pancytopenia/etiology , Sepsis/etiology , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Fatal Outcome , Female , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Middle Aged , Pancytopenia/drug therapy , Prednisolone/therapeutic use , Severity of Illness IndexABSTRACT
A case of severe and irreversible pancytopenia secondary to acute primary cytomegalovirus infection in an immunocompetent woman is described. The patient presented with thrombocytopenia, lymphopenia, anemia, and abnormal liver function tests. Treatment with corticosteroids and intravenous immunoglobulin was ineffective in reconstituting hemopoiesis. The patient developed severe sepsis and eventually expired.
Subject(s)
Female , Humans , Middle Aged , Cytomegalovirus Infections/complications , Immunocompetence , Pancytopenia/etiology , Sepsis/etiology , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Fatal Outcome , Glucocorticoids/therapeutic use , Immunoglobulins, Intravenous/therapeutic use , Pancytopenia/drug therapy , Prednisolone/therapeutic use , Severity of Illness IndexABSTRACT
OBJECTIVE: To investigate plasma brain natriuretic peptide (BNP) concentrations in association with blood pressure (BP) at baseline and after antihypertensive drug treatment. PATIENTS AND METHODS: We prospectively examined 186 individuals with newly diagnosed essential hypertension without target organ damage, whose mean age was 48.7 +/- 10.9 years. Treatment initiation began with irbesartan 150 mg/day and was doubled at 4 weeks in cases of inadequate BP control. If indicated, at 8-week-follow-up hydrochlorothiazide 12.5 mg alone or with amlodipine 5-10 mg was added. BNP levels were measured at baseline and after 3 months of antihypertensive treatment. RESULTS: At baseline plasma BNP levels were found to be related to systolic BP (r = 0.27, P < 0.001), independent of age, sex, smoking status, BMI and left ventricular mass index estimated by echocardiography (beta = 11.81, SE = 3.82, P = 0.002). Additionally, higher BNP concentrations were observed in patients with stage 2 hypertension compared with those with stage 1 (median 38.9 vs. 29.9 pg/ml, P = 0.022). Multivariate analysis showed a positive association between BNP and systolic BP variability (beta = 0.03, SE = 0.01, P = 0.034). At follow-up, 64.7% of the participants who had achieved BP control showed decreased BNP levels in contrast to those with poor BP control (median change -14.5 vs. -1.3 and median range from -34.4 to -4.4 vs. -9.6 to 10.9, respectively, P < 0.001). CONCLUSION: In this hypertensive population, increased BNP concentrations are associated with higher BP levels and systolic BP variability. The fall of BNP observed in those who achieved BP control indicates that BNP could be used as a biochemical marker of effective BP control and target organ protection.
