title: Fatal pneumonia and viremia due to human parainfluenza virus type 1 in a patient with adult T-cell leukemia-lymphoma treated with mogamulizumab.
abstract: We report a case of fatal pneumonia and viremia due to human parainfluenza virus type 1 (HPIV-1) in a 65-year-old male patient with adult T-cell leukemia-lymphoma (ATL) treated with mogamulizumab, a brand-new therapeutic agent for ATL. To our knowledge, this is the first report describing viremia due to HPIV-1. After administering mogamulizumab, lymphocyte count in the blood was drastically decreased and the patient suffered from complicated infections including gram-negative bacterial sepsis, cytomegalovirus antigenemia and aspergillosis. Although these infections were successfully controlled by broad spectrum antimicrobial therapy, patchy ground-grass opacities in the both lungs were gradually worsened. He finally died due to acute respiratory failure. Since findings of the chest CT was consistent with typical patterns of viral pneumonia, we screened major respiratory viruses in the peripheral blood with multiplex PCR, and it turned out that RNA of HPIV-1 was positive. Although ATL cells were not detected in the autopsied lungs and a variety of other tissues, cytoplasmic inclusion bodies, which are commonly observed in RNA viral infection, were abundantly observed in the autopsied lung tissue. These findings suggest that mogamulizumab accomplished complete remission of ATL, while the chemotherapy-induced prolonged lymphopenia caused fatal pneumonia and viremia due to HPIV-1. As it has been well recognized that community respiratory viruses including HPIV-1 often cause fatal pneumonia in patients with leukemia, but also there is no specific treatment for HPIV-1, we have to enforce standard precautions especially when we treat leukemic patients with intensively immunosuppressive agents such as mogamulizumab.
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Tamaki
authors.affiliation: Department of Infectious Diseases, Respiratory and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kinjo
authors.affiliation: Department of Pathology and Oncology, Graduate School of Medicine and Faculty of Medicine, University of the Ryukyus, Japan.
authors.forename: Hajime
authors.initials: H
authors.lastname: Aoyama
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Tomoyose
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Japan; Bone Marrow Transplantation Center, Ryukyu University Hospital, Japan.
authors.forename: Sawako
authors.initials: S
authors.lastname: Nakachi
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Japan.
authors.forename: Taeko
authors.initials: T
authors.lastname: Hanashiro
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Japan; Bone Marrow Transplantation Center, Ryukyu University Hospital, Japan.
authors.forename: Natsuki
authors.initials: N
authors.lastname: Shimabukuro
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Japan.
authors.forename: Iori
authors.initials: I
authors.lastname: Tedokon
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Japan.
authors.forename: Kazuho
authors.initials: K
authors.lastname: Morichika
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nishi
authors.affiliation: Department of Internal Medicine, Heartlife Hospital, Japan.
authors.forename: Naoya
authors.initials: N
authors.lastname: Taira
authors.affiliation: Department of Infectious Diseases, Respiratory and Digestive Medicine, Faculty of Medicine, University of the Ryukyus, Japan.
authors.forename: Jiro
authors.initials: J
authors.lastname: Fujita
authors.affiliation: Department of Pathology and Oncology, Graduate School of Medicine and Faculty of Medicine, University of the Ryukyus, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Yoshimi
authors.affiliation: Laboratory of Immunohematology, School of Health Sciences, Faculty of Medicine, University of the Ryukyus, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Fukushima
authors.affiliation: Division of Endocrinology, Diabetes and Metabolism, Hematology and Rheumatology, Department of Medicine, Graduate School of Medicine, University of the Ryukyus, Japan. Electronic address: hiroaki@med.u-ryukyu.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Masuzaki
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000150:complications* / Q000188:drug therapy; D008297:Male; D010222:Parainfluenza Virus 1, Human; D011024:Pneumonia, Viral; D010253:Respirovirus Infections; D014766:Viremia
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; C549035:mogamulizumab
keywords: Adult T-cell leukemia–lymphoma; Mogamulizumab; Parainfluenza virus type 1; Viral pneumonia; Viremia