title: Immune reconstitution complicated by CMV retinitis in a pediatric patient who underwent haploidentical CD34+-selected hematopoietic stem cell transplant for acute lymphoblastic leukemia.
abstract: 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.
authors.affiliation: Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy. simone.cesaro@unipd.it.
authors.forename: Simone
authors.initials: S
authors.lastname: Cesaro
authors.affiliation: Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Boaro
authors.affiliation: Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Pillon
authors.affiliation: Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Calore
authors.affiliation: Service of Pediatric Ophthalmology, Department of Pediatrics, University of Padova, Padova, Italy.
authors.forename: Ivete
authors.initials: I
authors.lastname: Cermakova
authors.affiliation: Division of Hematology and Clinical Immunology, Department of Clinical and Experimental Medicine, IRCCS Foundation on Transplantation Biotechnologies, University of Perugia, Perugia, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Perruccio
authors.affiliation: Department of Histology, Microbiology and Medical Biotechnology, University of Padova, Padova, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Mengoli
authors.affiliation: Pediatric Hematology Oncology, Department of Pediatrics, University of Padova, Via Giustiniani 3, 35128, Padova, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Messina
mesh_terms: 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*
chemical_list: D018952:Antigens, CD34