title: Human herpesvirus 6 infection mimicking juvenile myelomonocytic leukemia in an infant.
abstract: In vitro cell culture studies of bone marrow and peripheral blood progenitor cells from patients with juvenile myclomonocytic leukemia (JMML) consistently show spontaneous proliferation and selective hypersensitivity to granulocyte-macrophage colony-stimulating factor (GM-CSF). This GM-CSF hypersensitivity dose-response assay has become a component of the international diagnostic criteria for JMML. The authors report a 2-week-old boy with perinatal human herpesvirus 6 (HHV-6) infection in whom in vitro bone marrow culture studies suggested the diagnosis of JMML by showing increased spontaneous proliferation, inhibition of this growth by anti-GM-CSF antibodies, and hypersensitivity to GM-CSF. Polymerase chain reaction viral studies from whole blood DNA and the shell vial viral culture assay were both positive for HHV-6. The patient's condition improved with expectant treatment, with an eventual return to normal blood counts and resolution of hepatosplenomegaly. This case of perinatal HHV-6 infection shows that viruses can initially mimic the in vitro culture results found in patients with JMML. It also illustrates that patients suspected of having JMML should be observed if there are no signs of progressive disease and concurrent features suggestive of viral infection.
authors: Department of Pediatrics, St. John Hospital, Detroit, Michigan 48236, USA. adonis.lorenzana@stjohn.org
authors: Adonis
authors: A
authors: Lorenzana
authors: Hernando
authors: H
authors: Lyons
authors: Hadi
authors: H
authors: Sawaf
authors: Martha
authors: M
authors: Higgins
authors: Donald
authors: D
authors: Carrigan
authors: Peter D
authors: PD
authors: Emanuel
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology; D001853:Bone Marrow / Q000473:pathology; D001854:Bone Marrow Cells / Q000187:drug effects; D002478:Cells, Cultured / Q000187:drug effects; D003114:Colony-Forming Units Assay; D004279:DNA, Viral / Q000097:blood; D003937:Diagnosis, Differential; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000037:antagonists & inhibitors / Q000494:pharmacology; D015654:Herpesvirus 6, Human / Q000254:growth & development / Q000302:isolation & purification*; D006801:Humans; D007231:Infant, Newborn; D007567:Jaundice, Neonatal / Q000150:complications; D015479:Leukemia, Myelomonocytic, Acute / Q000175:diagnosis*; D008297:Male; D016133:Polymerase Chain Reaction; D019349:Roseolovirus Infections / Q000150:complications / Q000175:diagnosis*; D014776:Virus Cultivation
chemical_list: D004279:DNA, Viral; D016178:Granulocyte-Macrophage Colony-Stimulating Factor