# Cytomegalovirus-Associated Septic Shock Leading to Disseminated Intravascular Coagulation

## TL;DR

A 58-year-old immunosuppressed woman developed life-threatening CMV-related septic shock and DIC, which improved with aggressive treatment including antiviral therapy and supportive care.

## Contribution

This paper presents a rare clinical case of CMV-induced septic shock and DIC in an immunosuppressed patient, emphasizing the importance of early detection and aggressive treatment.

## Key findings

- CMV viral load was elevated in a patient with septic shock and DIC.
- Aggressive treatment with ganciclovir and supportive care improved clinical outcomes.
- Early identification and management of CMV infections can prevent life-threatening complications.

## Abstract

Cytomegalovirus (CMV) is typically asymptomatic in the immunocompetent but can cause deadly complications in the immunosuppressed. We report a rare case of a 58-year-old woman with stage IIIb chronic kidney disease, membranous glomerulonephritis, and diabetes mellitus who presented with profound weakness, watery diarrhea, and rectal bleeding. First managed for suspected infectious colitis, urinary tract infection, and acute kidney injury, she deteriorated quickly with confusion, hypotension, and fever. Severe metabolic acidosis, coagulopathy, and thrombocytopenia suggesting disseminated intravascular coagulation (DIC) were noted in laboratory results. The patient developed septic shock, needing intensive care, mechanical ventilation, and renal replacement therapy. CMV viral load was elevated, confirming the diagnosis of CMV-associated septic shock with DIC; the patient had an improved clinical response followed ganciclovir in conjunction with broad-spectrum antibiotics and extensive supportive care, including transfusions of fresh frozen plasma, cryoprecipitate, platelets, packed red blood cells, and vitamin K. Three weeks of targeted antiviral therapy and comprehensive supportive care allowed the patient's renal function, coagulation parameters, and clinical status to improve such that the patient could be safely discharged. This case highlights the need for early identification and very aggressive management of CMV infections in immunosuppressed patients to prevent life-threatening complications such as septic shock and DIC.