Cytomegalovirus pneumonia in a pediatric patient with solid tumor

Abstract

Cytomegalovirus (CMV) infection is an important cause of morbidity and mortality in immunosuppressed patients. CMV infection is mostly encountered in children undergoing highdose chemotherapy and transplantation. Though the chemotherapy for solid tumor is an immunosuppressed state, CMV infection has been reported infrequently in children with solid tumors. In this paper, a child diagnosed with neuroblastoma who was treated with conventional chemotherapy and developed CMV pneumonia is presented. The patient was treated with intravenous ganciclovir in the pediatric intensive care unit, but died one week later.

Keywords

• -

Solid tümörlü bir çocukta sitomegalovirüs pnömonisi

Öz

Sitomegalovirüs (CMV) enfeksiyonu bağışıklığı baskılanmış hastalarda morbidite ve mortalitenin önemli bir nedenidir. Solid tümör kemoterapisi bağışıklığı baskılayan bir durum olmasına rağmen, sitomegalovirüs hastalığı bildirilmesi sık değildir. CMV enfeksiyonu daha çok yüksek doz tedavi ve transplantasyon geçiren hastalarda bildirilmektedir. Bu yazıda konvansiyonel kemoterapi gören ve sitomegalovirüs pnömonisi gelişen nöroblastom tanılı bir hasta sunulmaktadır. Hasta pediatrik yoğun bakım biriminde intravenöz gansiklovir ile tedavi edildi. Ancak bir hafta sonra hasta kaybedildi.

Anahtar Kelimeler

• Ganciclovir, pneumonia, cytomegalovirus

References

1. 1. Taylor GH. Cytomegalovirus. Am Fam Physician 2003;67(3):519-24.
2. 2. Betts RF, Hanshaw JB. Cytomegalovirus (CMV) in the compromised host(s). Annu Rev Med 1977;28:103-10.
3. 3. Rowling AJ, Kvalsvig AJ, Sharples PM, Foot AB, Unsworth DJ. Pneumocystis carinii, cytomegalovirus, and severe transient immunodeficiency. J Clin Pathol 2003;56(9):718-9.
4. 4. Erakgun T, Afrashi F, Nalbantgil S, Ozbaran M, Mentes J. Asymptomatic cytomegalovirus retinitis after cardiac transplantation. Ophthalmologica 2003;217(6):446-50.
5. 5. Schroten H, Manz S, Köhler H, Wolf U, Brockmann M, Riedel F. Fatal desquamative interstitial pneumonia associated with proven CMV infection in an 8- month-old boy. Pediatr Pulmonol 1998;25(5):345-7.
6. 6. Chemaly RF, Torres HA, Hachem RY, Nogueras GM, Aguilera EA, Younes A, et al. Cytomegalovirus pneumonia in patients with lymphoma. Cancer 2005;104(6):1213-20.
7. 7. Akhtar N, Ni J, Langston C, Demmler GJ, Towbin JA. PCR diagnosis of viral pneumonitis from fixed-lung tissue in children. Biochem Mol Med 1996;58(1):66- 76.
8. 8. Vivarelli M, De Ruvo N, Lazzarotto T, Bellusci R, Landini MP, Varani S, et al. Abstension from treatment of low-level pp65 cytomegalovirus antigenemia after liver transplantation: a prospective study. Transplantation 2000;70(8):1183-7.

9. 9. Gentile G, Picardi A, Capobianchi A, Spagnoli A, Cudillo L, Dentamaro T, et al. A prospective study comparing quantitative Cytomegalovirus (CMV) polymerase chain reaction in plasma and pp65 antigenemia assay in monitoring patients after allogeneic stem cell transplantation. BMC Infect Dis 2006;6:167.
10. 10. Spach DH, Bauwens JE, Myerson D, Mustafa MM, Bowden RA. Cytomegalovirus-induced hemorrhagic cystitis following bone marrow transplantation. Clin Infect Dis 1993;16(1):142-4.
11. 11. Bielorai B, Shulman LM, Rechavi G, Toren A. CMV reactivation induced BK virus-associated late onset hemorrhagic cystitis after peripheral blood stem cell transplantation. Bone Marrow Tr a n s p l a n t 2001;28(6):613-4.
12. 12.Biron KK. Antiviral drugs for cytomegalovirus diseases. Antiviral Res 2006;71(2-3):154-63.
13. 13. Nogueira E, Ozaki KS, Tomiyama H, Granato CF, Camara NO, Pacheco-Silva A. The emergence of cytomegalovirus resistance to ganciclovir therapy in kidney transplant recipients. Int Immunopharmacol 2006;6(13-14):2031-7.
14. 14.Bueno J, Ramil C, Green M. Current management strategies for the prevention and treatment of cytomegalovirus infection in pediatric transplant recipients. Paediatr Drugs 2002;4(5):279-90.
15. 15. Machado CM, Dulley FL, Boas LS, Castelli JB, Macedo MC, Silva RL, et al. CMV pneumonia in allogeneic BMT recipients undergoing early treatment of pre-emptive ganciclovir therapy. Bone Marrow Transplant 2000;26(4):413-7.
16. 16. Pérez Mato S, Van Dyke RB. Pulmonary infections in children with HIV infection. Semin Respir Infect 2002;17(1):33-46.