Fatal adenovirus infection indistinguishable from thrombotic microangiopathy after allogeneic CD34+ peripheral progenitor cell transplantation.
A 10-year-old boy with acute lymphoblastic leukemia in second relapse received CD34+ purified allogeneic peripheral blood stem cell transplantation (PBSCT) from his HLA-haploidentical father. The patient developed grade II acute GVHD and received high-dose methyl-prednisolone starting on day + 13 posttransplant. Renal dysfunction followed by massive gastrointestinal bleeding was observed from day + 14. The laboratory findings including elevated serum LDH, increased RBC fragmentation, higher level of thrombomodulin and undetectable haptoglobin corresponded with the diagnosis of thrombotic microangiopathy (TMA). In spite of various treatments, the patient died of multiple organ failure on day + 93. Post-mortem examination revealed systemic adenovirus infection without histological findings of TMA. Severe adenovirus infection may be confused with TMA, and should be distinguished by rapid virological assay.
Yabe
Hiromasa
H
Specialized Clinical Science, Pediatrics, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa 259-1193, Japan. yabeh@is.icc.u-tokai.ac.jp
Hattori
Kinya
K
Inoue
Hiroyasu
H
Matsumoto
Masae
M
Hamanoue
Satoshi
S
Hiroi
Aiko
A
Koike
Takashi
T
Kato
Shunichi
S
Shimamura
Kazuo
K
Yabe
Miharu
M
D000257:Adenoviridae Infections / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D018952:Antigens, CD34 / Q000276:immunology*; D001344:Autopsy; D002648:Child; D004847:Epithelial Cells / Q000276:immunology / Q000473:pathology / Q000821:virology; D017809:Fatal Outcome; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007422:Intestines / Q000276:immunology / Q000473:pathology / Q000821:virology; D008297:Male; D009336:Necrosis; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology / Q000601:surgery / Q000821:virology; D014184:Transplantation, Homologous; D017211:Treatment Failure; D014652:Vascular Diseases / Q000175:diagnosis* / Q000473:pathology
D018952:Antigens, CD34