Transfusion-Associated Cytomegalovirus Mononucleosis

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Abstract
Transfusion-associated cytomegalovirus mononucleosis generally occurs as a complication of extracorporeal circulation following cardiac surgery. Three cases following trauma were recognized in < 1 yr. Massive and limited volume blood transfusions were involved. Hectic fever was a characteristic feature in these otherwise remarkably asymptomatic individuals without the classic features of heterophile-positive infectious mononucleosis. Since the illness developed several weeks into the post-operative period after extensive thoracic or abdominal trauma surgery, the presence of an undrained abscess was the major diagnostic concern. Atypical lymphocytosis, markers of altered immunity (cold agglutinins, rheumatoid factor) and moderate hepatic dysfunction were important laboratory clues. In 1 case focal isotope defects in the spleen scan misleadingly suggested a septic complication. A false-positive monospot test initially obscured the correct serologic diagnosis in the same patient. Failure to consider this self-limited viral infection may be a critical factor leading to unnecessary surgery. Other viral agents [Epstein Barr, rubeola and Colorado tick fever viruses] capable of eliciting a similar syndrome are cited.