A single institution case series of
adenovirus infections after allogeneic
hematopoietic stem cell transplantation is presented to highlight the consideration for
adenovirus infections as an etiology in patients with rapid hepatic or other sudden organ deterioration in the setting of apparent GVHD stabilization. The series also highlights that survival is limited with these
infections often due in part to concomitant
opportunistic infections. In addition, the pathophysiological events, such as GVHD and hepatic dysfunction, may complicate the clinical picture and delay
therapy of an
opportunistic infection. This is particularly true for adenoviral
infections as they also have a distinct clinical picture in immunocompromised patients when compared to immune competent patients.
Adenovirus infections also have the additional challenge that its treatment,
cidofovir, has associated toxicities that can delay its administration. Recent developments has yielded an assay that can be used in the early detection and for serial determinations of adenovirus in patients with advanced GVHD, as well as a new therapeutic agent currently undergoing clinical trials.