title: Fatal human metapneumovirus infection following allogeneic hematopoietic stem cell transplantation.
abstract: Respiratory viruses are an important yet underestimated cause of infectious morbidity and mortality in immunocompromised children and adolescents. Here, we report the occurrence of fatal lower respiratory tract disease associated with human metapneumovirus (HMPV) infection in a 10-year-old girl with chronic graft-versus-host disease following allogeneic hematopoietic stem cell transplantation (HSCT) for secondary chronic myeloid leukemia. Symptoms occurred 8 months after HSCT while on immunosuppression with 0.2 mg/kg/day of prednisone, and presented as dry cough, bilateral pneumonitis, and progressive respiratory distress. Non-invasive and invasive microbiological investigations revealed HMPV type B as the sole pathogen. Histopathological findings showed interstitial and intra-alveolar pneumonitis with profound alveolar cell damage. The patient was treated with intravenous and oral ribavirin and polyvalent immunoglobulins, but ultimately died from respiratory failure. The case reflects the potentially fatal impact of infections by respiratory viruses in immunocompromised patients and the need for effective approaches to their prevention and treatment.
authors.affiliation: Infectious Disease Research Program, Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Dokos
authors.forename: K
authors.initials: K
authors.lastname: Masjosthusmann
authors.forename: G
authors.initials: G
authors.lastname: Rellensmann
authors.forename: C
authors.initials: C
authors.lastname: Werner
authors.forename: S
authors.initials: S
authors.lastname: Schuler-Lüttmann
authors.forename: K-M
authors.initials: KM
authors.lastname: Müller
authors.forename: M
authors.initials: M
authors.lastname: Schiborr
authors.forename: K
authors.initials: K
authors.lastname: Ehlert
authors.forename: A H
authors.initials: AH
authors.lastname: Groll
mesh_terms: D002648:Child; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D029121:Metapneumovirus / Q000302:isolation & purification*; D018184:Paramyxoviridae Infections / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D014184:Transplantation, Homologous / Q000009:adverse effects