title: Fatal disseminated adenoviral infection associated with thrombotic thrombocytopenic purpura after allogeneic bone marrow transplantation.
abstract: Adenoviruses are increasingly recognized as a significant cause of morbidity and mortality in immunocompromised patients. We report on a patient who, approximately 4 weeks after allogeneic stem cell transplantation, developed fever, new liver lesions and thrombotic microangiopathy. Adenovirus type 2 was isolated from blood and urine samples. Liver biopsy showed parenchymal necrosis with intranuclear viral inclusion bodies. Immunohistochemistry was positive for adenovirus. In addition, on electron microscopy the morphologic pattern was highly suggestive of adenovirus. The patient died on post-transplant day 40. The relatively early post-transplant presentation of disseminated adenoviral disease and its possible association with a TTP-like picture are rather unusual after allogeneic transplantation.
authors.affiliation: Department of Medicine, Greenebaum Cancer Center, University of Maryland, Baltimore, USA. FassasAthanasios@exchange.uams.edu
authors.forename: A B
authors.initials: AB
authors.lastname: Fassas
authors.forename: L N
authors.initials: LN
authors.lastname: Buddharaju
authors.forename: A
authors.initials: A
authors.lastname: Rapoport
authors.forename: M
authors.initials: M
authors.lastname: Cottler-Fox
authors.forename: C
authors.initials: C
authors.lastname: Drachenberg
authors.forename: B
authors.initials: B
authors.lastname: Meisenberg
authors.forename: G
authors.initials: G
authors.lastname: Tricot
mesh_terms: D000257:Adenoviridae Infections / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D020522:Lymphoma, Mantle-Cell / Q000150:complications / Q000628:therapy; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D011697:Purpura, Thrombotic Thrombocytopenic / Q000209:etiology*; D014184:Transplantation, Homologous / Q000009:adverse effects