Differential outcome of neurological HCMV infection in two hematopoietic stem cell transplant recipients

BMC Infectious Diseases

Fausto Baldanti³  Marco Zecca¹  Emilio Paolo Alessandrino²  Mario Regazzi Bonora⁴  Milena Furione³  Paola Villani⁴  Vanina Rognoni³  Giovanna Giorgiani¹  Anna Amelia Colombo² 

[1] Struttura Complessa di Ematologia ed Oncologia Pediatrica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;Centro Trapianti di Midollo Osseo, Istituto di Ematologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;Struttura Semplice Virologia Molecolare, Struttura Complessa Virologia e Microbiologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy;Dipartimento di Farmacologia, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy

关键词: HSCT;    T-cell depleted;    CNS;    HCMV;   

Others  :  1159653
DOI  :  10.1186/1471-2334-12-238

 received in 2012-06-07, accepted in 2012-09-26,  发布年份 2012

【 摘 要 】

Background

Human cytomegalovirus (HCMV) infection of the central nervous system (CNS) is a rare but life threatening condition which may follow hematopoietic stem cell transplantation. Diagnosis, monitoring and treatment approaches rely on anecdotal reports.

Case presentations

The different outcomes of HCMV CNS disease in an adult and a pediatric T-cell depleted hematopoietic stem cell transplant (HSCT) recipient are reported. In the first case, HCMV encephalitis emerged in the context of simultaneous impairment of the T- and B-cell immunity. Antiviral treatment only reduced viral load in peripheral blood and the patient died. In the second case, an HCMV radiculopathy was observed and antiviral treatment was adjusted on the basis of intrathecal drug level. In addition, donor HCMV-specific cytotoxicT lymphocytes (CTLs) were infused. Viral load in the CNS decreased and the patient recovered from the acute event. In neither case were drug-resistant HCMV variants observed in blood or CNS samples.

Conclusions

T-cell depleted HSCT appears a predisposing condition for CNS HCMV infection since never observed in other HSCT recipients at our center in the last 15 years. Intensive diagnostic approaches and timely aggressive combination treatments might improve clinical outcome in these patients.

【 授权许可】

   
2012 Colombo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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