Immune reconstitution complicated by CMV retinitis in a pediatric patient who underwent haploidentical CD34+-selected hematopoietic stem cell transplant for acute lymphoblastic leukemia.
We describe two episodes of CMV retinitis in a pediatric patient who underwent a CD34+ selected graft from his haploidentical father. Both recipient and donor were cytomegalovirus (CMV) seropositive. Both episodes occurred late post-grafting during a phase of complete immunological recovery with sufficient numbers of circulating CMV-specific clones. Antiviral treatment with foscarnet and ganciclovir was successful but prolonged treatment was required to prevent relapses. We hypothesize that this complication was more related to an immune reconstitution process than to an immune-deficient state post-grafting. We conclude that CMV retinitis is a late complication of HSCT that can occur despite satisfactory immune reconstitution. Usually, it is responsive to antiviral therapy. Dilated fundoscopic examination is essential both for examining patients with reduced visual acuity and for screening asymptomatic patients.
Cesaro
Simone
S
Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy. simone.cesaro@unipd.it.
Boaro
Maria Paola
MP
Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
Pillon
Marta
M
Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
Calore
Elisabetta
E
Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
Cermakova
Ivete
I
Service of Pediatric Ophthalmology, Department of Pediatrics, University of Padova, Padova, Italy.
Perruccio
Katia
K
Division of Hematology and Clinical Immunology, Department of Clinical and Experimental Medicine, IRCCS Foundation on Transplantation Biotechnologies, University of Perugia, Perugia, Italy.
Mengoli
Carlo
C
Department of Histology, Microbiology and Medical Biotechnology, University of Padova, Padova, Italy.
Messina
Chiara
C
Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
D000293:Adolescent; D019264:Adoptive Transfer; D018952:Antigens, CD34 / Q000378:metabolism; D003586:Cytomegalovirus Infections / Q000209:etiology* / Q000276:immunology; D006239:Haplotypes; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006412:Hematopoietic Stem Cells / Q000378:metabolism; D006801:Humans; D016867:Immunocompromised Host; D015458:Leukemia, T-Cell / Q000276:immunology / Q000628:therapy; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000276:immunology* / Q000628:therapy*; D020127:Recovery of Function / Q000276:immunology; D012173:Retinitis / Q000209:etiology / Q000276:immunology / Q000821:virology*
D018952:Antigens, CD34