Fatal adenovirus hepatitis during maintenance therapy for childhood acute lymphoblastic leukemia.
Disseminated adenoviral infection with hepatitis is rare in children undergoing standard chemotherapy. We report on a 3(1/2)-year-old male with fatal adenovirus hepatitis receiving maintenance chemotherapy for acute lymphoblastic leukemia (ALL). Adenoviral hepatitis was proven by histology, viral culture, and PCR in a liver biopsy. Quantitative real-time PCR in the peripheral blood showed adenoviral DNA copy number >10(9)/ml. Despite aggressive supportive care and antiviral treatment with cidofovir, the patient died rapidly due to fulminant liver failure. Diagnostic and treatment options for adenovirus infection remain unsatisfactory for these patients. We propose suggestions for diagnosis and therapy.
Steiner
Isabelle
I
Division of Pediatric Hematology/Oncology, University Children's Hospital, Inselspital, Bern, Switzerland.
Aebi
Christoph
C
Ridolfi Lüthy
Annette
A
Wagner
Bendicht
B
Leibundgut
Kurt
K
D000258:Adenovirus Infections, Human / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D002675:Child, Preschool; D000077404:Cidofovir; D003199:Computer Systems; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D004279:DNA, Viral / Q000097:blood; D017809:Fatal Outcome; D006525:Hepatitis, Viral, Human / Q000188:drug therapy / Q000209:etiology*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D015122:Mercaptopurine / Q000008:administration & dosage / Q000009:adverse effects; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D009102:Multiple Organ Failure / Q000209:etiology; D063065:Organophosphonates / Q000627:therapeutic use; D016133:Polymerase Chain Reaction; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy*; D011239:Prednisolone / Q000008:administration & dosage / Q000009:adverse effects; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D014766:Viremia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
D000998:Antiviral Agents; D004279:DNA, Viral; D063065:Organophosphonates; D014750:Vincristine; D003596:Cytosine; D011239:Prednisolone; D015122:Mercaptopurine; D001215:Asparaginase; D000077404:Cidofovir; D008727:Methotrexate