title: A Case of Adenovirus Viremia in a Pediatric Liver Transplant Recipient With Neutropenia and Lymphopenia: Who and When Should We Treat?
abstract: Human adenovirus (HAdV) is one of the most feared infections among immunocompromised patients. In particular, in liver transplant patients, HAdV has been implicated in acute liver failure with resultant mortality. The development of current molecular techniques and surveillance testing protocols have provided tools for early detection of HAdV infection, prior to or at the early onset of HAdV disease. Although reduction in immune suppression is the mainstay of therapy, many researchers have also advocated for early administration of antiviral therapy. In multiple reports, cidofovir treatment has been associated with declines in HAdV viral loads or clinical improvement in solid organ and bone marrow transplant recipients. However, there have also been case reports that raise questions about the effectiveness of antiviral therapy in controlling systemic HAdV disease. We report a case of a 26-month-old male recipient of a liver transplantation for hepatoblastoma who developed adenoviremia with an associated hepatitis and gastroenteritis. He recovered with reduced immune suppression but without antiviral therapy, thus avoiding potential toxicities associated with cidofovir therapy. This case a contrast to previous reports, and it highlights the ambiguity regarding which patients should receive HAdV-specific antiviral therapy. Additional knowledge regarding specific pediatric host factors and HAdV factors that predict poor outcomes are needed. Such information would allow clinicians to better stratify patients by risk at the time of adenoviremia detection so that low-risk patients are not unnecessarily exposed to medications with potential toxicities.
authors.affiliation: Division of Infectious Diseases.
authors.forename: R R
authors.initials: RR
authors.lastname: Patel
authors.affiliation: Division of Clinical Virology Laboratory, The Children's Hospital of Philadelphia, Pennsylvania; Departments of Division of Pathology, and the.
authors.forename: R L
authors.initials: RL
authors.lastname: Hodinka
authors.affiliation: Division of Infectious Disease Program, Lovelace Respiratory Research Institute, Albuquerque, New Mexico.
authors.forename: A E
authors.initials: AE
authors.lastname: Kajon
authors.affiliation: Division of Infectious Diseases Division of Center for Pediatric Clinical Effectiveness, and the.
authors.forename: S
authors.initials: S
authors.lastname: Klieger
authors.affiliation: Division of Infectious Diseases.
authors.forename: Z
authors.initials: Z
authors.lastname: Oikonomopoulou
authors.affiliation: Division of Infectious Disease Program, Lovelace Respiratory Research Institute, Albuquerque, New Mexico.
authors.forename: H
authors.initials: H
authors.lastname: Petersen
authors.affiliation: Division of Gastroenterology and.
authors.forename: E
authors.initials: E
authors.lastname: Rand
authors.affiliation: Division of Oncology, the.
authors.forename: E F
authors.initials: EF
authors.lastname: Attiyeh
authors.affiliation: Division of Infectious Diseases Division of Center for Pediatric Clinical Effectiveness, and the Division of Center for Clinical Epidemiology and Biostatistics, The Perelman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia.
authors.forename: B T
authors.initials: BT
authors.lastname: Fisher
mesh_terms: D000258:Adenovirus Infections, Human / Q000150:complications / Q000378:metabolism / Q000628:therapy* / Q000821:virology; D000260:Adenoviruses, Human / Q000502:physiology*; D002675:Child, Preschool; D018197:Hepatoblastoma / Q000150:complications / Q000378:metabolism / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008113:Liver Neoplasms / Q000150:complications / Q000378:metabolism / Q000601:surgery; D016031:Liver Transplantation; D008231:Lymphopenia / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D008297:Male; D009503:Neutropenia / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D019562:Viral Load; D014766:Viremia / Q000150:complications / Q000378:metabolism / Q000628:therapy*
chemical_list: D007166:Immunosuppressive Agents
keywords: adenovirus; cidofovir; orthotopic liver transplant.