title: Multiple viral infections after haploidentical hematopoietic stem cell transplantation in a child with acute lymphoblastic leukemia.
abstract: After allogeneic hematopoietic stem cell transplantation (HSCT), viral infections/reactivations are a frequent complication, sometimes with fatal outcome. Thus, early diagnosis is recommended by screening of whole blood or plasma preparations using highly sensitive molecular techniques that test for the most common viral pathogens, such as Epstein-Barr virus, cytomegalovirus, and adenoviruses (ADVs). Despite this approach, not every reactivation/infection can be adequately detected or excluded, even with highly sensitive polymerase chain reaction. Particularly after toxic treatment, uncommon infections or infections resistant to first-line treatment can occur, even in unusual locations. Herein, we present the case of a child with Philadelphia chromosome-positive acute lymphoblastic leukemia after allogeneic HSCT who suffered from 5 different viral reactivations/infections, including acyclovir-resistant herpes simplex virus type 1 esophagitis, human herpesvirus 6 encephalitis, rotavirus gastroenteritis, respiratory syncytial virus pneumonia, and ADV esophagitis, despite routinely performed blood examinations for viral pathogens remaining unrevealing at all times.
authors.affiliation: Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität Jena, Jena, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Ernst
authors.forename: A
authors.initials: A
authors.lastname: Sauerbrei
authors.forename: A
authors.initials: A
authors.lastname: Krumbholz
authors.forename: R
authors.initials: R
authors.lastname: Egerer
authors.forename: H-J
authors.initials: HJ
authors.lastname: Mentzel
authors.forename: M
authors.initials: M
authors.lastname: Kurzai
authors.forename: R
authors.initials: R
authors.lastname: Häfer
authors.forename: J F
authors.initials: JF
authors.lastname: Beck
authors.forename: B
authors.initials: B
authors.lastname: Gruhn
mesh_terms: D000260:Adenoviruses, Human / Q000302:isolation & purification; D000293:Adolescent; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D015654:Herpesvirus 6, Human / Q000302:isolation & purification; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D012136:Respiratory Syncytial Viruses / Q000302:isolation & purification; D012401:Rotavirus / Q000302:isolation & purification; D014184:Transplantation, Homologous / Q000009:adverse effects; D014775:Virus Activation; D014777:Virus Diseases / Q000175:diagnosis* / Q000473:pathology / Q000821:virology*