Sequential adenovirus infection of type 14 hemorrhagic cystitis and type 35 generalized infection after cord blood transplantation.
We report a case of a 29-year-old male patient with a generalized adenovirus (AdV) infection after cord blood transplantation (CBT) for acute myelocytic leukemia with maturation at 2nd complete remission. Before engraftment, hemorrhagic cystitis was caused by AdV, which resulted in hydronephrosis, renal failure, and adenoviremia on day 34. Forced diuresis, hemodialysis, withdrawal of cyclosporin A, and administration of gamma-globulin or vidarabine were not effective and the patient died of pulmonary alveolar hemorrhage on day 67. At autopsy, old inflammatory change only was observed in the bladder section. In the lungs and kidneys, granular deposits in the nucleus and a high copy number of AdV-DNA were observed. Molecular diagnosis using PCR-restriction fragment length polymorphism analysis demonstrated that AdV with the serotype 14 caused the cystitis. However, retrospective genome typing using PCR sequencing revealed the infection of AdV serotype 35 in the kidneys, lungs, and serum. The present case suggested that Adv infection could not be always caused by a single AdV serotype, and suggested that multiple serotype infection was very difficult to treat. It is desired that a consensus regarding the treatment of AdV infections is established.
Abe
Takashi
T
Division of Hematology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Asahimachi-dori 754, Niigata, 951-8510, Japan. abetaka@med.niigata-u.ac.jp.
Furukawa
Tatsuo
T
Division of Bone Marrow Transplantation, Niigata University Medical and Dental Hospital, Niigata, Japan.
Masuko
Masayoshi
M
Division of Bone Marrow Transplantation, Niigata University Medical and Dental Hospital, Niigata, Japan.
Sugimoto
Atsunori
A
Division of Hematology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Asahimachi-dori 754, Niigata, 951-8510, Japan.
Okazuka
Kiyoshi
K
Division of Hematology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Asahimachi-dori 754, Niigata, 951-8510, Japan.
Honma
Keiichiro
K
Division of Hematology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Asahimachi-dori 754, Niigata, 951-8510, Japan.
Fujimura
Takeo
T
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan.
Iguchi
Seitaro
S
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan.
Nishi
Shinichi
S
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan.
Ueno
Mitsuhiro
M
Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medicine and Dental Science, Niigata, Japan.
Nagahashi
Masayuki
M
Division of Molecular Diagnostic Pathology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Watanabe
Gen
G
Division of Molecular Diagnostic Pathology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Ajioka
Yoichi
Y
Division of Molecular Diagnostic Pathology, Niigata University Medical and Dental Hospital, Niigata, Japan.
Isahai
Noriatsu
N
Niigata Prefecture Central Hospital, Niigata, Japan.
Nagai
Koichi
K
Niigata Prefecture Central Hospital, Niigata, Japan.
Kazuyama
Yukumasa
Y
Kitazato-Otsuka Biomedical Assay Laboratories Co., LTD, Kanagawa, Japan.
Aizawa
Yosifusa
Y
Division of Hematology, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medicine and Dental Science, Asahimachi-dori 754, Niigata, 951-8510, Japan.
D000258:Adenovirus Infections, Human / Q000209:etiology*; D000328:Adult; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D003556:Cystitis / Q000209:etiology* / Q000473:pathology / Q000821:virology; D017809:Fatal Outcome; D006470:Hemorrhage / Q000209:etiology* / Q000821:virology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D001743:Urinary Bladder / Q000473:pathology