Artikel
Fatal Human Metapneumovirus Pneumonitis post Hematopoietic Stem Cell Transplantation
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Veröffentlicht: | 28. März 2013 |
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Objectives: Human Metapneumovirus (HMPV) is a common cause of respiratory viral infections in the community. Little is known about its relevance in immunocompromised children.
Methods: Case report of a fatal HMPV infection in patient with graft-versus-host disease (GVHD) following hematopoietic stem cell transplantation (HSCT).
Results: The patient was a 10-year-old girl with secondary CML and HSCT from a matched sibling donor after conditioning with busulphane, cyclophosphamide and melphalane. Recurrent CML post transplant was controlled by nilotinib plus donor lymphocytes, resulting in molecular remission but also, chronicGVHD. Eight months after transplantation, while on 5 mg/day of prednisone, the patient presented with dry cough and progressive respiratory distress. Laboratory investigations revealed a normal CBC and a CRP of 2.2 mg/dL. Total and CD4+-lymphocyte counts were 1920 and 328/uL, respectively. X-ray and CT imaging revealed bilateral patchy infiltrates and ground glass opacification. Bronchoscopy with BAL and throracoscopic lung biopsy demonstrated interstitial and intraalveolar pneumonits with signs of advanced alveolar damage, no evidence for bronchiolitis obliterans, CMV, PCP and fungi, but HMPV type B by PCR. Despite a 14-days course of intravenous ribavirin plus IVIG, steroid boluses, empiric antibacterial/antifungal treatment and maximum respiratory support, the patient did not recover and died three weeks later from irreversible lung failure without clearance of HMPV from respiratory secretions.
Conclusion: Although it is unclear whether HMPV was the sole or a contributing cause of fatal lower respiratory tract disease, the case demonstrates that HMPV needs to be considered as potentially serious respiratory viral pathogen in immunocompromised children.