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Development of CMV retinitis in an antigenemia-negative infant after cord blood transplantation.

Abstract
A five-month-old male infant with familial hemophagocytic lymphohistiocytosis underwent cord blood transplantation using reduced-intensity conditioning. Methylprednisolone (mPSL) pulse administration was performed for marked pulmonary edema during the early phase of transplantation, followed by GVHD treatment with mPSL until day 100. CMV antigenemia was detected on days 27 and 55, but serum became negative with 2- to 3-week ganciclovir (GCV) treatment on both occasions. On day 120, ophthalmological findings included multiple bilateral white spots and a positive PCR study using anterior chamber fluid confirmed the diagnosis of CMV retinitis affecting both eyes, although CMV antigenemia was negative. Re-treatment with GCV had a minimal effect on the ophthalmological findings, while foscarnet administration markedly improved the retinitis and decreased the CMV-DNA level. Considering that a substantial proportion of patients develop CMV retinitis even when CMV antigenemia is not present, routine monitoring involving ophthalmological examinations should be conducted for hematopoietic transplant patients, especially infants, who cannot complain of ocular symptoms.
AuthorsAkane Matsumoto, Katsutsugu Umeda, Koji Kawaguchi, Koji Kawada, Sayaka Maeda, Takako Kinehara, Satoshi Saida, Itaru Kato, Hidefumi Hiramatsu, Ken-Ichiro Watanabe, Takahiro Yasumi, Toshio Heike, Akitaka Tsujikawa, Akito Uji, Ikuya Usami, Kiminari Ito, Souichi Adachi
Journal[Rinsho ketsueki] The Japanese journal of clinical hematology (Rinsho Ketsueki) Vol. 56 Issue 5 Pg. 506-10 (05 2015) ISSN: 0485-1439 [Print] Japan
PMID26062674 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Drug Combinations
Topics
  • Cytomegalovirus Infections (drug therapy)
  • Drug Combinations
  • Fetal Blood (transplantation)
  • Humans
  • Infant
  • Male
  • Retinitis (drug therapy)

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