Cytomegalovirus-associated Disseminated Intravascular Coagulation in an Immunocompetent Patient: A Case Report and Literature Review.

A healthy 20-year-old woman presented with high fever and fatigue. Laboratory findings included normal complete blood counts and the absence of atypical lymphocytes. The patient had markedly elevated C-reactive protein, hyperferritinemia, and coagulation abnormalities consistent with disseminated intravascular coagulation, while imaging studies and extensive infectious and autoimmune workups were unremarkable. Serological testing and polymerase chain reaction confirmed a primary cytomegalovirus (CMV) infection. The administration of ganciclovir followed by corticosteroid therapy resulted in the improvement of the patient's clinical symptoms and laboratory findings. Clinicians should consider primary CMV infection in the differential diagnosis of severe coagulation abnormalities associated with a hyperinflammatory state, even in immunocompetent patients without atypical lymphocytosis.