Successful treatment with cidofovir for disseminated adenovirus infection accompanied by hemophagocytic syndrome and meningitis in an allogeneic hematopoietic stem cell transplantation recipient

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  • NAGAMATSU Kentaro
    Department of Hematology, Oita City Medical Association’s Almeida Memorial Hospital
  • TAKANO Kuniko
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • SAKATA Masanori
    Department of Hematology, Oita Prefectural Hospital
  • YANAI Yuka
    Department of Hematology, Oita City Medical Association’s Almeida Memorial Hospital
  • KATAYAMA Oju
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • HONDA Shuhei
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • YOSHIDA Natsumi
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • KAWANO Rie
    Department of Medical Oncology and Hematology, Oita University Faculty of Medicine
  • IMAMURA Tomoyuki
    Department of Hematology, Oita Memorial Hospital
  • OGATA Masao
    Department of Hematology, Oita University Hospital

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Other Title
  • Cidofovirが奏効した同種造血幹細胞移植後の血球貪食症候群と髄膜炎を伴った播種性アデノウイルス感染症
  • Cidofovir ガ ソウコウ シタ ドウシュ ゾウケツ カンサイボウ イショク ゴ ノ ケッキュウドンショク ショウコウグン ト ズイマクエン オ トモナッタ ハシュセイ アデノウイルス カンセンショウ

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Abstract

<p>A 65-year-old woman received bone marrow transplantation from an HLA-DRB1 one locus mismatched donor for high-risk myelodysplastic syndrome. On day 237 after transplantation, she developed recurrent acute gastrointestinal graft-versus-host disease and adenoviral hemorrhagic cystitis. Hence, the methylprednisolone (mPSL) dose was increased to 2 mg/kg, and mesenchymal stem cells were administered. After the dose was tapered, she developed high fever, gross hematuria, and progressive pancytopenia. Then, the serum LDH, ferritin, and hepatobiliary enzyme levels of the patient increased, and hemophagocytosis was observed based on bone marrow examination. The adenovirus DNA level in the plasma was 6.3×106 copies/ml on day 278, and the volume of cerebrospinal fluid increased. Hence, the patient was diagnosed with meningitis and disseminated adenovirus infection. On day 288, cidofovir was administered at a dose of 1 mg/kg three times a week for 8 doses. The mPSL dose was again increased to 2 mg/kg for the treatment of hemophagocytic syndrome. Then, the patient’s symptoms gradually improved, and the adenovirus viral load became negative on day 369. Based on the clinical course of our patient, cidofovir is useful for severe adenovirus infection.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 62 (4), 251-256, 2021

    The Japanese Society of Hematology

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