title: Persistent CMV infection after allogeneic hematopoietic stem cell transplantation in a CMV-seronegative donor-to-positive recipient constellation: Development of multidrug resistance in the absence of anti-viral cellular immunity.
abstract: We describe a case of persistent cytomegalovirus (CMV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT) with discordant and high-risk (D-/R+) constellation of CMV serostatus. Despite the use of different and innovative antiviral strategies, viral replication could not be suppressed successfully promoting a protracted CMV colitis associated with severe gastrointestinal graft-versus-host disease (GI GVHD). We illustrate that the development of multidrug viral resistance, the failure to mount a CMV-specific cellular immune response, as confirmed by QuantiFERON(®)-CMV (Qiagen) assay, and the refractory GVHD requiring prolonged immunosuppression were the main factors contributing to persistent viral replication and the fulminant unfavorable course.
authors.affiliation: Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Herling
authors.affiliation: Institute of Virology, University Hospital of Cologne, Cologne, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Schröder
authors.affiliation: Institute of Virology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Awerkiew
authors.affiliation: Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany.
authors.forename: Geothy
authors.initials: G
authors.lastname: Chakupurakal
authors.affiliation: Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Holtick
authors.affiliation: Institute of Virology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Rolf
authors.initials: R
authors.lastname: Kaiser
authors.affiliation: Institute of Virology, University Hospital of Cologne, Cologne, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Pfister
authors.affiliation: Department of Internal Medicine I, University Hospital of Cologne, Cologne, Germany.
authors.forename: Christof
authors.initials: C
authors.lastname: Scheid
authors.affiliation: Institute of Virology, University Hospital of Cologne, Cologne, Germany. Electronic address: veronica.di-cristanziano@uk-koeln.de.
authors.forename: Veronica
authors.initials: V
authors.lastname: Di Cristanziano
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use*; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000821:virology; D024921:Drug Resistance, Multiple, Viral; D005260:Female; D006086:Graft vs Host Disease; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007111:Immunity, Cellular; D016867:Immunocompromised Host; D014019:Tissue Donors; D066027:Transplant Recipients; D014184:Transplantation, Homologous / Q000009:adverse effects*
chemical_list: D000998:Antiviral Agents
keywords: Allogeneic hematopoietic stem cell transplantation; Cytomegalovirus; Multidrug resistance; QuantiFERON(®)-CMV assay