Suginobe Hidehiro, Nawa Nobutoshi, Ishida Hidekazu, Kogaki Shigetoyo
Department of Paeditatrics, Osaka University Graduate School of Medicine, Suita, Japan.
BMJ Case Rep. 2017 Aug 3;2017:bcr-2017-220342. doi: 10.1136/bcr-2017-220342.
In immunocompromised patients, respiratory syncytial virus (RSV) infections are known to be severe and prolonged, and have significant mortality and morbidity. However, little is known about the clinical courses and treatment strategy of RSV infection in heart transplant recipients. Here, we report a 6-year-old female with heart transplantation who had exhibited prolonged respiratory symptoms and shedding of RSV. She had received everolimus as an immunosuppressant. As immunosuppressants could have been responsible for the prolonged activation of RSV, we converted everolimus to mycophenolate mofetil. After the conversion, RSV promptly disappeared, and her symptoms improved. We speculate that converting the immunosuppressant may be effective for prolonged RSV infection due to the different immunosuppressive mechanisms.
在免疫功能低下的患者中，呼吸道合胞病毒（RSV）感染已知较为严重且病程迁延，具有显著的死亡率和发病率。然而，对于心脏移植受者中RSV感染的临床病程和治疗策略却知之甚少。在此，我们报告一名6岁接受心脏移植的女性，她出现了迁延的呼吸道症状且有RSV排出。她一直在使用依维莫司作为免疫抑制剂。由于免疫抑制剂可能是导致RSV长期激活的原因，我们将依维莫司换成了霉酚酸酯。换药后，RSV迅速消失，她的症状也有所改善。我们推测，由于免疫抑制机制不同，更换免疫抑制剂可能对RSV的长期感染有效。
