Stem Cell Transplantation Center, Hokkaido University Hospital, Kita-14, Nishi-5, Kita-ku, Sapporo, Hokkaido, 060-8638, Japan.
Int J Hematol. 2012 Feb;95(2):217-22. doi: 10.1007/s12185-012-1003-3. Epub 2012 Jan 20.
Cytomegalovirus (CMV) infection is latent in the majority of adult humans. The reactivation of CMV causes pneumonia and gastrointestinal disease in severely immunosuppressed patients, who consequently suffer very high mortality due to CMV central nervous system disease. We report here a case involving a 28-year-old female patient with mycosis fungoides who underwent umbilical cord blood transplantation three times and developed CMV ventriculoencephalitis. The patient's CMV viremia was successfully preempted with ganciclovir (GCV) as indicated by undetectable CMV antigenemia; despite this successful treatment, the patient developed CMV ventriculoencephalitis. Foscarnet (FCV) therapy led to a temporary recovery, after which CMV ventriculoencephalitis recurred, and the patient died after receiving combination GCV and FCV therapy. Autopsy samples revealed CMV ventriculoencephalitis, as indicated by numerous inclusion-bearing cells (Owl's eye). It is likely that this patient harbored a GCV-resistant CMV strain; however, it was not possible to obtain nucleic acids suitable for use in assessing this possibility.
巨细胞病毒（CMV）感染在大多数成年人群中呈潜伏状态。CMV 的再激活可导致严重免疫抑制患者发生肺炎和胃肠道疾病，由此导致 CMV 中枢神经系统疾病的极高死亡率。我们在此报告一例患有蕈样真菌病的 28 岁女性患者，该患者曾三次进行脐带血移植，并发生 CMV 脑室脑炎。该患者的 CMV 血症通过无法检测到的 CMV 抗原血症成功地被抢先使用更昔洛韦（GCV）预防；尽管进行了成功的治疗，但该患者仍发生了 CMV 脑室脑炎。膦甲酸（FCV）治疗导致暂时恢复，随后 CMV 脑室脑炎复发，在接受 GCV 和 FCV 联合治疗后患者死亡。尸检样本显示 CMV 脑室脑炎，存在大量包涵体细胞（猫头鹰眼）。该患者可能携带 GCV 耐药的 CMV 株；然而，无法获得适合用于评估这种可能性的核酸。
