Human herpesvirus-6 pneumonitis in a patient with follicular lymphoma following immunochemotherapy with rituximab
| Autor: | Yuji Shimura, Kazuna Tanba, Yayoi Matsumura-Kimoto, Yoshiaki Chinen, Yoshimi Mizuno, Tsutomu Kobayashi, Taku Tsukamoto, Saeko Kuwahara-Ota, Shigeo Horiike, Junya Kuroda, Shinsuke Mizutani, Tomoko Takimoto-Shimomura |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
viruses medicine.medical_treatment viral reactivation Follicular lymphoma Case Report lymphoma Hematopoietic stem cell transplantation Exanthema Subitum 03 medical and health sciences human herpesvirus-6 medicine Pharmacology (medical) Pneumonitis Pharmacology medicine.diagnostic_test biology business.industry pneumonitis medicine.disease biology.organism_classification Pneumonia 030104 developmental biology Infectious Diseases Bronchoalveolar lavage Immunology Human herpesvirus 6 Rituximab business medicine.drug |
| Zdroj: | Infection and Drug Resistance |
| ISSN: | 1178-6973 |
| DOI: | 10.2147/idr.s163686 |
| Popis: | Primary infection with human herpesvirus-6 (HHV-6) commonly occurs at an early age in children, most often at 3 years of age, and is associated with childhood diseases, such as exanthema subitum, hepatitis, febrile convulsions, or encephalitis. However, the virus occasionally reactivates from its latent state in immunosuppressed adults, especially post-transplant, resulting in serious disseminated, sometimes life-threatening end-organ complications. Herein, we report a case of a 68-year-old man with relapsed follicular lymphoma who developed HHV-6 pneumonitis. Eighteen months after achieving second complete remission by salvage immunochemotherapy with rituximab, the patient was complicated by pneumonia, with chest computed tomography finding showing disseminated nodular shadows with ground-glass opacity in both lungs. While empiric antibiotic and antifungal therapies did not improve the pneumonia, polymerase chain reaction–based viral screening tests on his bronchoalveolar lavage fluid detected the presence of HHV-6 DNA, and ganciclovir treatment quickly resolved the pneumonia, indicating that he suffered from HHV-6 pneumonitis. He had no other HHV-6–related end-organ damage, such as encephalitis. This case suggests that, although extremely rare, HHV-6 reactivation should be considered as one of the candidate pathogens for pulmonary complications of uncertain etiology in patients who have been treated with intensive immunosuppressive chemotherapy, even without hematopoietic stem cell transplantation. Furthermore, polymerase chain reaction–based viral screening testing on bronchoalveolar lavage fluid is a powerful diagnostic tool for pneumonitis due to viral reactivation, including HHV-6 reactivation. |
| Databáze: | OpenAIRE |
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