title: A fatal case of cytomegalovirus ventriculoencephalitis in a mycosis fungoides patient who received multiple umbilical cord blood cell transplantations.
abstract: Cytomegalovirus (CMV) infection is latent in the majority of adult humans. The reactivation of CMV causes pneumonia and gastrointestinal disease in severely immunosuppressed patients, who consequently suffer very high mortality due to CMV central nervous system disease. We report here a case involving a 28-year-old female patient with mycosis fungoides who underwent umbilical cord blood transplantation three times and developed CMV ventriculoencephalitis. The patient's CMV viremia was successfully preempted with ganciclovir (GCV) as indicated by undetectable CMV antigenemia; despite this successful treatment, the patient developed CMV ventriculoencephalitis. Foscarnet (FCV) therapy led to a temporary recovery, after which CMV ventriculoencephalitis recurred, and the patient died after receiving combination GCV and FCV therapy. Autopsy samples revealed CMV ventriculoencephalitis, as indicated by numerous inclusion-bearing cells (Owl's eye). It is likely that this patient harbored a GCV-resistant CMV strain; however, it was not possible to obtain nucleic acids suitable for use in assessing this possibility.
authors.affiliation: Stem Cell Transplantation Center, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan. t-matsukawa@med.hokudai.ac.jp
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Matsukawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Goto
authors.forename: Kenta
authors.initials: K
authors.lastname: Takahashi
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Asanuma
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yasumoto
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Takahata
authors.forename: Akio
authors.initials: A
authors.lastname: Shigematsu
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Endo
authors.forename: Junji
authors.initials: J
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hashino
authors.forename: Shinya
authors.initials: S
authors.lastname: Tanaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000328:Adult; D036101:Cord Blood Stem Cell Transplantation; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000276:immunology / Q000473:pathology; D018792:Encephalitis, Viral / Q000276:immunology / Q000473:pathology / Q000821:virology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D009182:Mycosis Fungoides / Q000276:immunology / Q000628:therapy*; D014775:Virus Activation / Q000276:immunology