Volume 14, Issue 2 ( June 2022 2022)
Iranian Journal of Blood and Cancer 2022, 14(2): 49-57 |
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Bahram Darbandi1 
, Parham Niyasti1 , Shohreh Maleknejad1 , Adel Baghersalimi1 , Houman Hashemian1 , Arezoo Karimzadeh * 2
, Parham Niyasti1 , Shohreh Maleknejad1 , Adel Baghersalimi1 , Houman Hashemian1 , Arezoo Karimzadeh * 2
1- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
2- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran , arezoo.krz.ak@gmail.com
2- Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran , arezoo.krz.ak@gmail.com
Abstract: (1018 Views)
Cytomegalovirus (CMV) is the leading cause of viral-associated congenital infections. Moreover, it can also be acquired. Between 50 to 80 percent of the world’s population is seropositive for CMV and most clinical disease occurs in individuals previously infected with CMV. Rarely, serious CMV infection has occurred in individuals with healthy immune system. In contrast to immunocompetent patients, higher morbidity and mortality of CMV end organ disease is considered in immunocompromised patients. According to available evidence, gastrointestinal (GI) disease has lower prevalence in case of CMV-induced organ involvement, especially in pediatric non-transplant acute leukemia. In this report, we present a 12-year-old girl, known case of acute lymphoblastic leukemia (ALL) receiving maintenance chemotherapy with manifestations of gastroenteritis and significant weight loss. Initial laboratory data, demonstrated mild pancytopenia especially lymphopenia and thrombocytopenia. After excluding more common etiologies, colonoscopy with multiple biopsies were taken which was indicative of CMV-colitis. Intravenous (IV) ganciclovir for 3 weeks and oral valganciclovir for about 9 months were initiated. Follow-up courses for CMV surveillance included blood qualitative CMV polymerase chain reaction (PCR) and colonoscopy with biopsy which were negative for CMV but tissue qualitative CMV PCR was positive for CMV in about 7 months after initiation of treatment. Oral treatment was decided to be continued. To sum up, plenty of guidelines have been developed in stem cell transplantation and human immunodeficiency virus (HIV) patients but non-transplant leukemic setting, is a neglected area in the field of CMV infection management.
: Case report |
Subject:
Pediatric Hematology & Oncology
Received: 2021/12/4 | Accepted: 2022/06/4 | Published: 2022/06/28
Received: 2021/12/4 | Accepted: 2022/06/4 | Published: 2022/06/28
References
1. Yan Z, Wang L, Dennis J, Doern C, Baker J, Park JY. Clinical significance of isolated cytomegalovirus-infected gastrointestinal cells. International journal of surgical pathology. 2014;22(6):492-8. [DOI:10.1177/1066896914537681]
2. Spaete RR, Gehrz RC, Landini MP. Human cytomegalovirus structural proteins. Journal of General Virology. 1994;75(12):3287-308. [DOI:10.1099/0022-1317-75-12-3287]
3. Lim Y, Lyall H. Congenital cytomegalovirus-who, when, what-with and why to treat? Journal of Infection. 2017;74:S89-S94. [DOI:10.1016/S0163-4453(17)30197-4]
4. Yassin MA, Nashwan AJ, Soliman AT, Yousif A, Moustafa A, AlBattah A, Mohamed SF, Mudawi DS, Elkourashy S, Asaari D-R. Cytomegalovirus-induced hemorrhagic colitis in a patient with chronic myeloid leukemia (chronic phase) on dasatinib as an upfront therapy. Clinical Medicine Insights: Case Reports. 2015;8:CCRep. S25327. [DOI:10.4137/CCRep.S25327]
5. Luo H, Lu J, Bai Y, Mao T, Wang J, Fan Q, Zhang Y, Zhao K, Chen Z, Gao S. Effect of camrelizumab vs placebo added to chemotherapy on survival and progression-free survival in patients with advanced or metastatic esophageal squamous cell carcinoma: the ESCORT-1st randomized clinical trial. Jama. 2021;326(10):916-25. [DOI:10.1001/jama.2021.12836]
6. Pass RF. Epidemiology and transmission of cytomegalovirus. The Journal of infectious diseases. 1985;152(2):243-8. [DOI:10.1093/infdis/152.2.243]
7. Gopakumar K, Thankamony P, Rajeswari B, Chandar R. Resolution of cytomegalovirus pneumonia in a child with acute leukemia without antiviral pharmacotherapy; The need to tailor your approach. Indian Journal of Medical and Paediatric Oncology. 2019;40(2):295. [DOI:10.4103/ijmpo.ijmpo_9_18]
8. Phasuk N, Keatkla J, Rattanasiri S, Techasaensiri C, Anurathapan U, Apiwattanakul N. Monitoring of cytomegalovirus infection in non-transplant pediatric acute lymphoblastic leukemia patients during chemotherapy. Medicine. 2019;98(4). [DOI:10.1097/MD.0000000000014256]
9. Reddy Y, Baig M, Kalva N, Puli S, Dhillon S. Cytomegalovirus Proctitis in a Patient with Chronic Lymphocytic Leukemia on Ibrutinib Therapy: A Case Report. Cureus. 2020;12(4). [DOI:10.7759/cureus.7837]
10. Ng AP, Worth L, Chen L, Seymour JF, Prince HM, Slavin M, Thursky K. Cytomegalovirus DNAemia and disease: incidence, natural history and management in settings other than allogeneic stem cell transplantation. haematologica. 2005;90(12):1672-9.
11. Cho MJ, Lee J, Hu J-Y, Lee JW, Cho S-Y, Lee D-G, Lee S. Cytomegalovirus appendicitis with concurrent bacteremia after chemotherapy for acute leukemia. The Korean journal of internal medicine. 2014;29(5):675. [DOI:10.3904/kjim.2014.29.5.675]
12. Eyrich M, Wiegering V, Lim A, Schrauder A, Winkler B, Schlegel PG. Immune function in children under chemotherapy for standard risk acute lymphoblastic leukaemia-a prospective study of 20 paediatric patients. British journal of haematology. 2009;147(3):360-70. [DOI:10.1111/j.1365-2141.2009.07862.x]
13. Molai Tavana P, Khalili M, Alavi S. CMV-induced Duodenal Papillitis in a Child with Acute Lymphoblastic Leukemia. مجله ی خون و سرطان ایران. 2019;11(4):150-2.
14. Jain R, Trehan A, Mishra B, Singh R, Saud B, Bansal D. Cytomegalovirus disease in children with acute lymphoblastic leukemia. Pediatric hematology and oncology. 2016;33(4):239-47. [DOI:10.3109/08880018.2016.1173147]
15. Handous I, Achour B, Marzouk M, Rouis S, Hazgui O, Brini I, Khelif A, Hannachi N, Boukadida J. Co-infections of human herpesviruses (CMV, HHV-6, HHV-7 and EBV) in non-transplant acute leukemia patients undergoing chemotherapy. Virology journal. 2020;17(1):1-15. [DOI:10.1186/s12985-020-01302-4]
16. Tormo M, Giménez E, Calabuig M, Talaya A, Navarro B, Amat P, Martín I, Albert E, Solano C, Navarro D. Cytomegalovirus DNAemia in patients with de novo acute myeloid leukemia undergoing cytotoxic chemotherapy. Leukemia & Lymphoma. 2019. [DOI:10.1080/10428194.2019.1613541]
17. An J, Brownell J, Barker D, Stockinger T, Brady R, Cebe K, Baur R. Cytomegalovirus Colitis Masquerading as Apple-Core Lesion after Systemic Chemotherapy in a Patient with Relapsed Acute Myeloid Leukemia. Case Reports in Oncological Medicine. 2018;2018. [DOI:10.1155/2018/5683417]
18. Kanvinde S, Bhargava P, Patwardhan S. Cytomegalovirus infection as a cause of cytopenia after chemotherapy for hematological malignancies. Indian pediatrics. 2013;50(2):197-201. [DOI:10.1007/s13312-013-0066-4]
19. Osawa R, Singh N. Cytomegalovirus infection in critically ill patients: a systematic review. Critical Care. 2009;13(3):1-10. [DOI:10.1186/cc7875]
20. Torres H, Aguilera E, Safdar A, Rohatgi N, Raad I, Sepulveda C, Luna M, Kontoyiannis D, Chemaly R. Fatal cytomegalovirus pneumonia in patients with haematological malignancies: an autopsy-based case-control study. Clinical microbiology and infection. 2008;14(12):1160-6. [DOI:10.1111/j.1469-0691.2008.02106.x]
21. Ko J-H, Peck K, Lee W, Huh K, Yoo J, Kim K, Cho S, Ha Y, Kang C-I, Chung D. Risk factors for cytomegalovirus gastrointestinal diseases in adult patients with cancer. European Journal of Clinical Microbiology & Infectious Diseases. 2014;33(10):1847-53. [DOI:10.1007/s10096-014-2107-x]
22. Cotte L, Drouet E, Bissuel F, Denoyel G, Trepo C. Diagnostic value of amplification of human cytomegalovirus DNA from gastrointestinal biopsies from human immunodeficiency virus-infected patients. Journal of clinical Microbiology. 1993;31(8):2066-9. [DOI:10.1128/jcm.31.8.2066-2069.1993]
23. Wu G-D, Shintaku P, Chien K, Geller SA. A comparison of routine light microscopy, immunohistochemistry, and in situ hybridization for the detection of cytomegalovirus in gastrointestinal biopsies. American Journal of Gastroenterology (Springer Nature). 1989;84(12).
24. Francis N, Boylston A, Roberts A, Parkin J, Pinching A. Cytomegalovirus infection in gastrointestinal tracts of patients infected with HIV-1 or AIDS. Journal of clinical pathology. 1989;42(10):1055-64. [DOI:10.1136/jcp.42.10.1055]
25. Kandiel A, Lashner B. Cytomegalovirus colitis complicating inflammatory bowel disease. American Journal of Gastroenterology. 2006;101(12):2857-65. [DOI:10.1111/j.1572-0241.2006.00869.x]
26. Beaugerie L, Cywiner-Golenzer C, Monfort L, Girard P-M, Carbonnel F, Ngô Y, Cosnes J, Rozenbaum W, Nicolas J-C, Châtelet F-P. Definition and diagnosis of cytomegalovirus colitis in patients infected by human immunodeficiency virus. JAIDS Journal of Acquired Immune Deficiency Syndromes. 1997;14(5):423-9. [DOI:10.1097/00042560-199704150-00005]
27. McCoy MH, Post K, Sen JD, Chang HY, Zhao Z, Fan R, Chen S, Leland D, Cheng L, Lin J. qPCR increases sensitivity to detect cytomegalovirus in formalin-fixed, paraffin-embedded tissue of gastrointestinal biopsies. Human pathology. 2014;45(1):48-53. [DOI:10.1016/j.humpath.2013.07.040]
28. Einsele H, Ehninger G, Hebart H, Weber P, Dette S, Link H, Horny H, Meuter V, Wagner S, Waller H. Incidence of local CMV infection and acute intestinal GVHD in marrow transplant recipients with severe diarrhoea. Bone marrow transplantation. 1994;14(6):955-63.
29. Green ML, Leisenring W, Stachel D, Pergam SA, Sandmaier BM, Wald A, Corey L, Boeckh M. Efficacy of a viral load-based, risk-adapted, preemptive treatment strategy for prevention of cytomegalovirus disease after hematopoietic cell transplantation. Biology of Blood and Marrow Transplantation. 2012;18(11):1687-99. [DOI:10.1016/j.bbmt.2012.05.015]
30. Ruell J, Barnes C, Mutton K, Foulkes B, Chang J, Cavet J, Guiver M, Menasce L, Dougal M, Chopra R. Active CMV disease does not always correlate with viral load detection. Bone marrow transplantation. 2007;40(1):55-61. [DOI:10.1038/sj.bmt.1705671]
31. Boeckh M, Ljungman P. How we treat cytomegalovirus in hematopoietic cell transplant recipients. Blood. 2009;113(23):5711-9. [DOI:10.1182/blood-2008-10-143560]
32. Ljungman P, Reusser P, De la Camara R, Einsele H, Engelhard D, Ribaud P, Ward K. Management of CMV infections: recommendations from the infectious diseases working party of the EBMT. Bone marrow transplantation. 2004;33(11):1075-81. [DOI:10.1038/sj.bmt.1704505]
33. Totadri S, Radhakrishnan V. Successful treatment of cytomegalovirus pneumonia in a child on maintenance chemotherapy for acute lymphoblastic leukemia without the use of intravenous immunoglobulin. Pediatric Hematology Oncology Journal. 2017;2(1):19-20. [DOI:10.1016/j.phoj.2017.05.003]
34. Kim JW, Boo S-J, Ye BD, Kim CL, Yang S-K, Kim J, Kim SA, Park SH, Park S-K, Yang D-H. Clinical utility of cytomegalovirus antigenemia assay and blood cytomegalovirus DNA PCR for cytomegaloviral colitis patients with moderate to severe ulcerative colitis. Journal of Crohn's and Colitis. 2014;8(7):693-701. [DOI:10.1016/j.crohns.2013.12.014]
35. Hantz S, Garnier-Geoffroy F, Mazeron M-C, Garrigue I, Merville P, Mengelle C, Rostaing L, Saint Marcoux F, Essig M, Rerolle J-P. Drug-resistant cytomegalovirus in transplant recipients: a French cohort study. Journal of antimicrobial chemotherapy. 2010;65(12):2628-40. [DOI:10.1093/jac/dkq368]
36. Kwon H, Lee HH, Paik CR, Lim Y-J, Park JA. Toxic megacolon and interstitial pneumonia caused by cytomegalovirus infection in a pediatric patient with acute lymphoblastic leukemia receiving chemotherapy. Blood research. 2016;51(4):281. [DOI:10.5045/br.2016.51.4.281]
37. Yoshida A, Hitomi S, Fukui T, Endo H, Morisawa Y, Kazuyama Y, Osumi K, Oka S, Kimura S. Diagnosis and monitoring of human cytomegalovirus diseases in patients with human immunodeficiency virus infection by use of a real-time PCR assay. Clinical infectious diseases. 2001;33(10):1756-61. [DOI:10.1086/323782]
38. Cotte L, Drouet E, Bailly F, Vitozzi S, Denoyel G, Trepo C. Cytomegalovirus DNA level on biopsy specimens during treatment of cytomegalovirus gastrointestinal disease. Gastroenterology. 1996;111(2):439-44. [DOI:10.1053/gast.1996.v111.pm8690210]
39. Suárez-Lledó M, Marcos MÁ, Cuatrecasas M, Bombi JA, Fernández-Avilés F, Magnano L, Martínez-Cibrián N, Llobet N, Rosiñol L, Gutiérrez-García G. Quantitative PCR is faster, more objective, and more reliable than immunohistochemistry for the diagnosis of cytomegalovirus gastrointestinal disease in allogeneic stem cell transplantation. Biology of Blood and Marrow Transplantation. 2019;25(11):2281-6. [DOI:10.1016/j.bbmt.2019.07.016]
40. Ljungman P, Boeckh M, Hirsch HH, Josephson F, Lundgren J, Nichols G, Pikis A, Razonable RR, Miller V, Griffiths PD. Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials. Clinical Infectious Diseases. 2016:ciw668. [DOI:10.1093/cid/ciw668]
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