title: Cytomegalovirus Disease in Children With Acute Lymphoblastic Leukemia in the Nontransplant Setting: Case Series and Review of the Literature.
abstract: Cytomegalovirus (CMV) disease in pediatric acute lymphoblastic leukemia in the nontransplant setting is very rare. We report our experience with 4 such cases, and review the literature (n=12). The median age at diagnosis was 10 years and 50% of patients were males. Among the 11 cases with available information at the time of diagnosis, CMV disease occurred during maintenance therapy in 10 patients. Fever was present in 9 cases. CMV disease manifested as retinitis in 6, hepatosplenic disease in 3, pneumonitis in 1, and hemophagocytic lymphohistiocytosis in 1 patient. One patient had both CMV retinitis and CMV-related hemophagocytic lymphohistiocytosis. Four of the 7 patients with retinitis complained of visual disturbance at diagnosis. CMV viremia was present in 10 patients. Three patients had at least 1 relapse and developed permanent visual defects, and 1 patient developed recurrent retinal detachment. In conclusion, prolonged immunosuppression is the major etiology and retinitis is the most common manifestation of CMV disease. As a significant number of patients with retinitis are asymptomatic, early diagnosis and treatment is important to prevent permanent visual loss.
authors.affiliation: *Department of Pediatric Hematology and Oncology, Bahrami Hospital, Tehran University of Medical Sciences ‡Mahak Hospital §Department of Virology, Iran University of Medical Sciences, Tehran, Iran †Division of Oncology, Washington University School of Medicine, St Louis, MO.
authors.forename: Aliakbar
authors.initials: A
authors.lastname: Rahbarimanesh
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Ehsani
authors.forename: Maedeh
authors.initials: M
authors.lastname: Karahroudi
authors.forename: Armin
authors.initials: A
authors.lastname: Rashidi
authors.forename: Motahareh
authors.initials: M
authors.lastname: Aghajani
authors.forename: Alipasha
authors.initials: A
authors.lastname: Meysami
authors.forename: Elham
authors.initials: E
authors.lastname: Shahgholi
authors.forename: Azim
authors.initials: A
authors.lastname: Mehrvar
authors.forename: Maryam
authors.initials: M
authors.lastname: Tashvighi
authors.forename: Hossein
authors.initials: H
authors.lastname: Keyvani
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000472:pathogenicity*; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D011014:Pneumonia / Q000188:drug therapy / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications* / Q000821:virology; D011379:Prognosis; D012173:Retinitis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000998:Antiviral Agents