ABSTRACT
Although advances in immunosuppression and antimicrobial prophylaxis have led to improved patient and graft survival, respiratory viruses continue to be a common cause of morbidity and mortality in immunocompromised populations. We describe the clinical manifestations, diagnosis and treatment options for influenza, respiratory syncytial virus and adenovirus infection in the kidney transplant population.
Subject(s)
Adenovirus Infections, Human/chemically induced , Graft Rejection/prevention & control , Immunosuppressive Agents/adverse effects , Influenza, Human/chemically induced , Kidney Failure, Chronic/surgery , Kidney Transplantation , Respiratory Syncytial Virus Infections/chemically induced , Respiratory Tract Infections/chemically induced , Adenovirus Infections, Human/diagnosis , Adenovirus Infections, Human/therapy , Antiviral Agents/therapeutic use , Humans , Influenza Vaccines/therapeutic use , Influenza, Human/diagnosis , Influenza, Human/prevention & control , Influenza, Human/therapy , Respiratory Syncytial Virus Infections/diagnosis , Respiratory Syncytial Virus Infections/therapy , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/therapyABSTRACT
A 59-year-old man with T-cell prolymphocytic leukemia on alemtuzumab presented with neutropenic fever, intermittent nausea, and multiple ill-defined low attenuation foci in the liver on abdominal computed tomography scan which were suspicious for metastatic disease. Histological examination revealed the diagnosis of adenovirus hepatitis. Patient responded well to cidofovir. Adenovirus hepatitis is a rare but important entity to be considered by the clinicians, radiologists, and pathologists. Timely diagnosis and appropriate management are essential to improve the prognosis of adenovirus hepatitis in immunocompromised patients.
Subject(s)
Adenovirus Infections, Human/chemically induced , Antibodies, Monoclonal, Humanized/adverse effects , Antineoplastic Agents/adverse effects , Chemotherapy-Induced Febrile Neutropenia/etiology , Hepatitis, Viral, Human/chemically induced , Immunocompromised Host , Leukemia, Prolymphocytic, T-Cell/drug therapy , Liver/diagnostic imaging , Adenovirus Infections, Human/diagnostic imaging , Alemtuzumab , Hepatitis, Viral, Human/diagnostic imaging , Humans , Male , Middle Aged , Tomography, X-Ray ComputedSubject(s)
Adenovirus Infections, Human/chemically induced , Adenoviruses, Human , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Pneumonia, Viral/chemically induced , Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy , Adenovirus Infections, Human/diagnostic imaging , Adenovirus Infections, Human/therapy , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Child, Preschool , Humans , Male , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/therapy , Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnostic imaging , Precursor Cell Lymphoblastic Leukemia-Lymphoma/virology , RadiographySubject(s)
Adenovirus Infections, Human/chemically induced , Adenoviruses, Human , Antineoplastic Agents/adverse effects , Boronic Acids/adverse effects , Cystitis/chemically induced , Hemorrhage/chemically induced , Multiple Myeloma/drug therapy , Pyrazines/adverse effects , Adenovirus Infections, Human/pathology , Aged , Antineoplastic Agents/administration & dosage , Boronic Acids/administration & dosage , Bortezomib , Cystitis/pathology , Cystitis/virology , Female , Hemorrhage/pathology , Hemorrhage/virology , Humans , Multiple Myeloma/pathology , Multiple Myeloma/virology , Pyrazines/administration & dosageABSTRACT
Rituximab is an anti-CD20 monoclonal antibody used in the treatment of B-cell proliferative disorders. Although it is very effective in many cases, a number of case reports in the literature have described fatal viral reactivations associated with rituximab therapy. We report what is to our knowledge the first case of fatal adenoviral hepatitis in a patient with Waldenstrom macroglobulinemia treated with rituximab. This case is a new example of an emerging pattern of association between rituximab therapy and fatal viral reactivations, and it urges increased vigilance when using rituximab-based treatment regimens.
Subject(s)
Adenovirus Infections, Human/chemically induced , Antibodies, Monoclonal/adverse effects , Hepatitis, Viral, Human/chemically induced , Immunologic Factors/adverse effects , Adenoviridae/isolation & purification , Adenoviridae/physiology , Adenovirus Infections, Human/pathology , Adenovirus Infections, Human/virology , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Murine-Derived , Fatal Outcome , Hepatitis, Viral, Human/pathology , Hepatitis, Viral, Human/virology , Humans , Immunologic Factors/therapeutic use , Immunologic Techniques , Liver/pathology , Liver/virology , Male , Microscopy, Electron , Middle Aged , Rituximab , Staining and Labeling , Virus Activation , Waldenstrom Macroglobulinemia/drug therapyABSTRACT
Infectious complications due to adenovirus are of increasing concern after allogeneic stem cell transplantation. Over the past 4 years, we have modified our conditioning regimens to use alemtuzumab in preference to anti-thymocyte globulin (ATG) for pediatric patients receiving stem cell transplants from alternate donors. Recent reports in adult studies implicate alemtuzumab as a risk factor for adenovirus infection. We therefore evaluated the incidence of adenovirus infection in pediatric patients receiving either ATG or alemtuzumab in their conditioning regimens. Of the 111 patients evaluated, a total of 54 patients received ATG and 57 patients received alemtuzumab. In total, 35/111 (32%) patients were infected by adenovirus, and 9/111 (8%) had adenovirus disease (AD). Adenovirus infection was greater in the alemtuzumab group than the ATG group (23/57 vs 12/54) (P=0.039) and disseminated AD was more frequent in the alemtuzumab group vs the ATG group (8/57 and 1/54 respectively) (P=0.032). The presence of Grade 3-4 graft-versus-host disease was a risk factor for adenovirus infection. Our findings highlight the fact that adenovirus infection is a frequent complication after stem cell transplantation from alternate donors in the pediatric population and that alemtuzumab increases the risk of infection compared to ATG. This work will help in identifying at-risk populations for our upcoming immunotherapy trial using adoptively transferred donor-derived adenovirus-specific cytotoxic T lymphocytes.