Development of CMV retinitis in an antigenemia-negative infant after cord blood transplantation

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  • MATSUMOTO Akane
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • UMEDA Katsutsugu
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • KAWAGUCHI Koji
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • MAEDA Sayaka
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • KINEHARA Takako
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • SAIDA Satoshi
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • KATO Itaru
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • HIRAMATSU Hidefumi
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • WATANABE Ken-ichiro
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • YASUMI Takahiro
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • HEIKE Toshio
    Department of Pediatrics, Graduate School of Medicine, Kyoto University
  • TSUJIKAWA Akitaka
    Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University
  • UJI Akito
    Department of Ophthalmology and Visual Sciences, Graduate School of Medicine, Kyoto University
  • USAMI Ikuya
    Department of Pediatrics, Hyogo Prefectural Tsukaguchi Hospital
  • ITO Kiminari
    Department of Hematology, Shinko Hospital
  • ADACHI Souichi
    Department of Human Health Science, Graduate School of Medicine, Kyoto University Graduate School

Bibliographic Information

Other Title
  • 臍帯血移植後に血中抗原陰性であった乳児に発症したCMV網膜炎
  • 症例報告 臍帯血移植後に血中抗原陰性であった乳児に発症したCMV網膜炎
  • ショウレイ ホウコク サイタイケツ イショク ゴ ニ ケッチュウ コウゲン インセイ デ アッタ ニュウジ ニ ハッショウ シタ CMV モウマクエン

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Abstract

A five-month-old male infant with familial hemophagocytic lymphohistiocytosis underwent cord blood transplantation using reduced-intensity conditioning. Methylprednisolone (mPSL) pulse administration was performed for marked pulmonary edema during the early phase of transplantation, followed by GVHD treatment with mPSL until day 100. CMV antigenemia was detected on days 27 and 55, but serum became negative with 2- to 3-week ganciclovir (GCV) treatment on both occasions. On day 120, ophthalmological findings included multiple bilateral white spots and a positive PCR study using anterior chamber fluid confirmed the diagnosis of CMV retinitis affecting both eyes, although CMV antigenemia was negative. Re-treatment with GCV had a minimal effect on the ophthalmological findings, while foscarnet administration markedly improved the retinitis and decreased the CMV-DNA level. Considering that a substantial proportion of patients develop CMV retinitis even when CMV antigenemia is not present, routine monitoring involving ophthalmological examinations should be conducted for hematopoietic transplant patients, especially infants, who cannot complain of ocular symptoms.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 56 (5), 506-510, 2015

    The Japanese Society of Hematology

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