Τίτλος:
Human herpesvirus 6-related pure red cell aplasia, secondary graft
failure, and clinical severe immune suppression after allogeneic
hematopoietic cell transplantation successfully treated with foscarnet
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
P>Human herpesvirus 6 (HHV-6) is frequently detected after allogeneic
hematopoietic cell transplantation (allo-HCT); however, the clinical
interpretation of HHV-6 viremia in a transplant patient is challenging
as it may signify asymptomatic reactivation, chromosomal integration of
the virus genome in the donor or recipient with no clinical
significance, or severe HHV-6 disease. Here we present a case of HHV-6
disease after allo-HCT presenting as pure red cell aplasia, secondary
graft failure, and severe immunosuppression causing multiple severe
bacterial super-infections. Examination of pre-transplant patient and
donor samples as well as serial determination of HHV-6 DNA copy numbers
after transplantation were necessary to definitively interpret HHV-6
viremia as active HHV-6 infection with a causative role in pancytopenia
and immune suppression. Foscarnet treatment resulted both in viral load
decline and disappearance of HHV-6-related bone marrow suppression and
predisposition to severe infections. Clinicians should be aware of the
wide array of clinical manifestations and the diagnostic pitfalls of
post-transplant HHV-6 disease. These issues are extremely challenging,
as they may result either in dangerous underestimation of HHV-6 disease
or in the institution of unnecessary antiviral therapy. Late bone marrow
aplasia and late severe infections after allo-HCT without other obvious
causes may be HHV-6 related.
Συγγραφείς:
Lagadinou, E. D.
Marangos, M.
Liga, M.
Panos, G. and
Tzouvara, E.
Dimitroulia, E.
Tiniakou, M.
Tsakris, A. and
Zoumbos, N.
Spyridonidis, A.
Περιοδικό:
Transplant Infectious Disease
Λέξεις-κλειδιά:
HHV-6; HCT; PRCA; severe immune suppression; foscavir; foscarnet;
allogeneic hematopoietic cell transplant
DOI:
10.1111/j.1399-3062.2010.00515.x
