Influenza A pneumonitis following treatment of acute cardiac allograft rejection with murine monoclonal anti-CD3 antibody (OKT3).
A 51-year-old man developed fever, cough, and dyspnea 5 days after completing murine monoclonal anti-CD3 antibody (OKT3) treatment for acute cardiac allograft rejection. Samples of BAL fluid grew influenza A virus. Progressive pulmonary infiltrates, respiratory compromise, and hypoxia developed, and the patient ultimately required 5 days of mechanical ventilation. Treatment with amantadine hydrochloride and ribavirin was prescribed, and the patient was discharged after 19 days. Influenza A virus has not been an important pathogen in cardiac transplant recipients. However, this is the first reported case of influenza A pneumonitis complicating anti-T lymphocyte therapy for cardiac allograft rejection. In comparison with our patient, two previously reported cases of influenza A infection in cardiac transplant patients have been less severe. The virulence of our patient's, life-threatening infection appears to be secondary to impairment of T lymphocyte-mediated immunity by OKT3. The role of therapeutic and even prophylactic amantadine therapy in this clinical setting has yet to be determined.
Embrey
R P
RP
Division of Cardiothoracic Surgery, University of Iowa College of Medicine, Iowa City, USA.
Geist
L J
LJ
D000547:Amantadine / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D006084:Graft Rejection / Q000276:immunology / Q000628:therapy*; D016027:Heart Transplantation / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D009980:Influenza A virus / Q000472:pathogenicity*; D008297:Male; D008875:Middle Aged; D016853:Muromonab-CD3 / Q000627:therapeutic use*; D011024:Pneumonia, Viral / Q000150:complications*; D011183:Postoperative Complications / Q000628:therapy*; D012254:Ribavirin / Q000627:therapeutic use; D014774:Virulence
D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D012254:Ribavirin; D000547:Amantadine