Nagamatsu Kentaro, Takano Kuniko, Sakata Masanori, Yanai Yuka, Katayama Oju, Honda Shuhei, Yoshida Natsumi, Kawano Rie, Imamura Tomoyuki, Ogata Masao
Department of Hematology, Oita City Medical Association's Almeida Memorial Hospital.
Department of Medical Oncology and Hematology, Oita University Faculty of Medicine.
Rinsho Ketsueki. 2021;62(4):251-256. doi: 10.11406/rinketsu.62.251.
A 65-year-old woman received bone marrow transplantation from an HLA-DRB1 one locus mismatched donor for high-risk myelodysplastic syndrome. On day 237 after transplantation, she developed recurrent acute gastrointestinal graft-versus-host disease and adenoviral hemorrhagic cystitis. Hence, the methylprednisolone (mPSL) dose was increased to 2 mg/kg, and mesenchymal stem cells were administered. After the dose was tapered, she developed high fever, gross hematuria, and progressive pancytopenia. Then, the serum LDH, ferritin, and hepatobiliary enzyme levels of the patient increased, and hemophagocytosis was observed based on bone marrow examination. The adenovirus DNA level in the plasma was 6.3×10 copies/ml on day 278, and the volume of cerebrospinal fluid increased. Hence, the patient was diagnosed with meningitis and disseminated adenovirus infection. On day 288, cidofovir was administered at a dose of 1 mg/kg three times a week for 8 doses. The mPSL dose was again increased to 2 mg/kg for the treatment of hemophagocytic syndrome. Then, the patient's symptoms gradually improved, and the adenovirus viral load became negative on day 369. Based on the clinical course of our patient, cidofovir is useful for severe adenovirus infection.
一名65岁女性因高危骨髓增生异常综合征接受了来自HLA - DRB1一个位点不匹配供者的骨髓移植。移植后第237天，她出现复发性急性胃肠道移植物抗宿主病和腺病毒性出血性膀胱炎。因此，甲泼尼龙（mPSL）剂量增加至2mg/kg，并给予间充质干细胞。剂量减量后，她出现高热、肉眼血尿和进行性全血细胞减少。随后，患者的血清乳酸脱氢酶、铁蛋白和肝胆酶水平升高，骨髓检查发现噬血细胞现象。第278天血浆中腺病毒DNA水平为6.3×10拷贝/ml，脑脊液量增加。因此，患者被诊断为脑膜炎和播散性腺病毒感染。第288天，给予西多福韦，剂量为1mg/kg，每周3次，共8剂。为治疗噬血细胞综合征，mPSL剂量再次增加至2mg/kg。随后，患者症状逐渐改善，第369天腺病毒载量转为阴性。根据我们患者的临床病程，西多福韦对严重腺病毒感染有效。
