HLA-mismatched CD34-selected stem cell transplant complicated by HHV-6 reactivation in the central nervous system
| Autor: | T. Kagechi, Michiya Kaneko, K Suenaga, Yoshifumi Wakata, Ryuji Nakagawa, A. Suzue, Yoichi Takaue, T. Miyazaki, Takanori Abe, Toshihiro Onishi, S. Kanamaru, Yasuhiro Kuroda, S. Kan-Nuki, Shinji Nagahiro, Hiroko Suzuya, Tsutomu Watanabe, Yoshifumi Kawano |
|---|---|
| Rok vydání: | 2000 |
| Předmět: |
Male
Ganciclovir Adolescent Herpesvirus 6 Human viruses Acyclovir Antigens CD34 medicine.disease_cause Antiviral Agents Polymerase Chain Reaction Herpesviridae Central nervous system disease Cerebrospinal fluid Antigens CD Meningoencephalitis medicine Humans Aplastic anemia Transplantation biology business.industry Histocompatibility Testing Hematopoietic Stem Cell Transplantation Anemia Aplastic virus diseases Herpesviridae Infections Hematology medicine.disease Magnetic Resonance Imaging Virus Diseases Immunology biology.protein Drug Therapy Combination gamma-Globulins Antibody business medicine.drug |
| Zdroj: | Bone Marrow Transplantation. 25:787-790 |
| ISSN: | 1476-5365 0268-3369 |
| DOI: | 10.1038/sj.bmt.1702220 |
| Popis: | We report here a patient who suffered from PCR- confirmed human herpesvirus type 6 (HHV-6) meningoencephalitis after allogeneic purified CD34+ cell transplantation from his HLA-mismatched sibling donor, even though he had been on intense prophylaxis with i.v. ganciclovir (GCV), acyclovir (ACV) and gamma-globulin containing a specific antibody against HHV-6. Serological evaluation disclosed that both the donor and recipient had IgG antibody against HHV-6 before transplantation. His blood WBC count started to transiently increase on day 10, and all blood components had decreased by day 20. He then developed a severe headache and high blood pressure, and sporadic abnormal neurological findings including nystagmus and delirium. An analysis of cerebrospinal fluid (CSF) revealed 8 cells/microl, a glucose level of 130 mg/dl and a protein level of 201 mg/dl (normal, 50 mg/dl) on day 26. At the time, HHV-6 was detected only in CSF by a PCR-based method and he was diagnosed as having meningoencephalitis due to the local reactivation of HHV-6. Although he failed to respond to high-dose therapy with ACV (60 mg/kg/day) and gamma-globulin, the DNA of this virus disappeared from the CNS upon treatment with GCV (30 mg/kg/day) combined with the intraventricular infusion of alpha-interferon. His clinical course was further complicated with meningoencephalitis due to staphylococcus epidermidis, and he died of tentorial herniation on day 79 without the recovery of blood components. This experience may indicate that intense prophylaxis to prevent reactivation of HHV-6 in the CNS is essential for the management of such profoundly immunosuppressed patients. |
| Databáze: | OpenAIRE |
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