Thrombosis associated with cytomegalovirus infection in patients with ANCA-positive vasculitis

Three cases of venous thrombosis with pulmonary embolism in two patients as sociated with underlying antineutrophil cytoplasmic autoantibody (ANCA)-pos itive vasculitis and reactivated cytomegalovirus (CMV) infection are descri bed. In vitro studies previously have shown that infection of endothelium w ith CMV increases the release of procoagulant factors and stimulates the ex pression of adhesion molecules. Because the endothelial cell plays a pivota l. role In maintaining the equilibrium between procoagulant and anticoagula nt states, injury by ANCA-positive, vasculitis and additional Infection wit h CMV may ignite a local thrombosis easily. Although venous thrombosis is u ncommon in CMV infection (eg, in the immunosuppressed state after organ tra nsplantation), the combination of vasculitis and reactivated CMV infection may have contributed to injury of the vessel wall with subsequent developme nt of thrombosis. A better awareness of this association could improve morb idity and may lead to prevention of potentially life-threatening pulmonary embolism. Patients with ANCA-positive vasculitis and CMV infection may prof it from prophylactic anticoagulant therapy with heparin or low-molecular-we ight heparin. (C) 2001 by the National Kidney Foundation, Inc.