Severe pancytopenia and hemophagocytosis after HHV-8 primary infection in a renal transplant patient successfully treated with foscarnet.
We report the occurrence of human herpesvirus (HHV)-8 primary infection in an adult male kidney recipient. Four months after transplantation, the patient developed visceral Kaposi sarcoma, and 1 month later he presented with progressive and severe peripheral cytopenia, in the presence of a normocellular or hypercellular bone marrow (BM) with hemophagocytosis. HHV-8 was the sole pathogen detected by polymerase chain reaction either in the serum or in the BM. HHV-8 latent nuclear antigen was detected in immature progenitor cells from the BM. Immunosuppressive therapy was reduced, and the patient was treated with foscarnet for 2 weeks, leading to a dramatic normalization of blood cell counts, concomitantly with the disappearance of HHV-8 viremia. At the end of antiviral therapy, the patient received chemotherapy, and Kaposi sarcoma regressed in 2 months. Severe peripheral cytopenia may be a posttransplant complication after HHV-8 infection, for which treatment with foscarnet seems appropriate.
Luppi
Mario
M
Department of Oncology and Hematology, University of Modena and Reggio Emilia, Modena, Italy.
Barozzi
Patrizia
P
Rasini
Valeria
V
Riva
Giovanni
G
Re
Alessandro
A
Rossi
Giuseppe
G
Setti
Gisella
G
Sandrini
Silvio
S
Facchetti
Fabio
F
Torelli
Giuseppe
G
D000998:Antiviral Agents / Q000008:administration & dosage*; D004279:DNA, Viral / Q000032:analysis; D017245:Foscarnet / Q000008:administration & dosage*; D019288:Herpesvirus 8, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010198:Pancytopenia / Q000188:drug therapy* / Q000821:virology; D010587:Phagocytosis / Q000187:drug effects; D012514:Sarcoma, Kaposi / Q000188:drug therapy*; D014766:Viremia / Q000188:drug therapy
D000998:Antiviral Agents; D004279:DNA, Viral; D017245:Foscarnet