Reactions 1309 - 10 Jul 2010

SAntineoplastics

Febrile neutropenia and CMV disease in a patientwith HIV infection: case report

A 50-year-old HIV positive man developed febrileneutropenia and disseminated cytomegalovirus (CMV)disease during antineoplastic therapy for plasmablasticlymphoma.

The man initiated antiretroviral therapy, andantimicrobial prophylaxis with aciclovir, fluconazole,azithromycin and cotrimoxazole [trimethoprim/sulfamethoxazole], prior to starting cyclophosphamide,doxorubicin, vincristine and prednisolone (CHOP)[dosages not stated]. He experienced several episodes ofneutropenic sepsis during the first five cycles of CHOP, forwhich he received empirical treatment. Eight days afterstarting the sixth cycle, he presented with a fever (39°C),dry cough and diarrhoea; he had noticed an enlarging skinlesion on his leg during the past week. Examination showeda dry eschar on his right thigh.

The man received piperacillin/tazobactam andgentamicin. Investigations revealed the following values:neutrophils 0.1 × 109/L, CRP 29, haemoglobin 7.4 g/dL, HIVRNA < 50 copies/mL and CD4 count 13 × 106 cells/L. Hisfever continued and metronidazole and amphotericin Bliposomal were added. His neutrophil count recovered byday 7 but his fever continued and his CRP level increasedfurther. He experienced dyspnoea on minimal exertion anda worsening cough. CT scan revealed widespread groundglass change in his lungs. He initiated antimicrobials forCMV pneumonitis and Mycobacterium aviumintracellularae complex. Although his fever resolved, hereported floaters and black shadows in his right eye.Neurological examination showed ataxia with lower limbdecreased tone and power and absent reflexes. Skin biopsyimmunostaining was positive for CMV cells andimmunostaining from bronchial washings was positive forCMV antibodies. Ganciclovir was started. Although hisCMV PCR decreased, his symptoms worsened and CMVretinitis was confirmed. Lower limb electromyocardiogramwas consistent with CMV polyradiculopathy. Foscarnetwas added and he improved. His cough and neurologicalsymptoms resolved and his skin lesions and retinitisimproved. He was discharged on valganciclovir.Ridha E, et al. Febrile neutropenia in a HIV positive individual post-chemotherapy.Journal of Clinical Virology 48: 2-5, No. 1, May 2010. Available from: URL:http://dx.doi.org/10.1016/j.jcv.2010.01.006 - United Kingdom 803024077

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Reactions 10 Jul 2010 No. 13090114-9954/10/1309-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved