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
| Autor: | G. Panos, E. Dimitroulia, M. Tiniakou, E.D. Lagadinou, Alexandros Spyridonidis, E. Tzouvara, Maria Liga, Athanassios Tsakris, Markos Marangos, N. Zoumbos |
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| Rok vydání: | 2010 |
| Předmět: |
Foscarnet
Transplantation Pathology medicine.medical_specialty business.industry viruses medicine.medical_treatment virus diseases Pure red cell aplasia Immunosuppression Bone Marrow Aplasia biochemical phenomena metabolism and nutrition medicine.disease Pancytopenia Infectious Diseases Bone marrow suppression Immunology medicine business Viral load medicine.drug |
| Zdroj: | Transplant Infectious Disease. 12:437-440 |
| ISSN: | 1398-2273 |
| DOI: | 10.1111/j.1399-3062.2010.00515.x |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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