Antineoplastics
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Reactions 1365 - 20 Aug 2011 S Antineoplastics EBV-related lymphoproliferative disorder, CMV reactivation and VZV encephalitis in an adolescent: case report A 14-year-old girl developed Epstein-Barr virus [EBV]- related lymphoproliferative disorder, cytomegalovirus [CMV] reactivation and varicella zoster virus [VZV] encephalitis during chemotherapy for medulloblastoma. After her diagnosis in April 2009, the girl had partial resection, then received chemoradiotherapy with systemic high-dose cyclophosphamide, vincristine, cisplatin and etoposide with intrathecal methotrexate and dexamethasone [routes and dosages not stated]. In October 2009, after 4 cycles, she developed persistent low- grade fever with vomiting and abdominal pain. Investigations revealed gastric mucosal lesions, and ulcerating lesions in her colon. She was diagnosed with lymphoproliferative disorder with EBV. Antineoplastic therapy was withdrawn. CMV antigen was found in her peripheral lymphocytes, and she had severe lymphopenia with decreased CD4+ cells. At this time, her language was noted to be inappropriate for her age, and she developed a rash on her face and abdomen, and unilateral facial palsy. PCR detected VZV in her cerebrospinal fluid. The girl received aciclovir and corticosteroids. She improved, with a negative VZV PCR, but her abdominal pain persisted. She received rituximab and then total parenteral support. Her stomach lesions resolved but her colonic lesions had minimal improvement. CMV was detected, and ganciclovir was initiated. After two further weeks, her colon lesions improved and she became negative for CMV antigen. At last follow-up she had no symptoms; her CD4+ cell depletion was noted for 18 months after antineoplastic withdrawal. Author comment: "[N]o reports have described co- infection of these three herpes viruses together, as in the present case. Severe immunosuppression by intensive chemotherapy with craniospinal radiotherapy for medulloblastoma might have caused this." Ohta M, et al. Epstein-Barr virus-related lymphoproliferative disorder, cytomegalovirus reactivation, and varicella zoster virus encephalitis during treatment of medulloblastoma. Journal of Medical Virology 83: 1582-1584, No. 9, Sep 2011. Available from: URL: http://dx.doi.org/10.1002/jmv.22136 - Japan 803059100 1 Reactions 20 Aug 2011 No. 1365 0114-9954/10/1365-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1365 - 20 Aug 2011
SAntineoplastics
EBV-related lymphoproliferative disorder, CMVreactivation and VZV encephalitis in anadolescent: case report
A 14-year-old girl developed Epstein-Barr virus [EBV]-related lymphoproliferative disorder, cytomegalovirus[CMV] reactivation and varicella zoster virus [VZV]encephalitis during chemotherapy for medulloblastoma.
After her diagnosis in April 2009, the girl had partialresection, then received chemoradiotherapy with systemichigh-dose cyclophosphamide, vincristine, cisplatin andetoposide with intrathecal methotrexate anddexamethasone [routes and dosages not stated]. InOctober 2009, after 4 cycles, she developed persistent low-grade fever with vomiting and abdominal pain.Investigations revealed gastric mucosal lesions, andulcerating lesions in her colon. She was diagnosed withlymphoproliferative disorder with EBV. Antineoplastictherapy was withdrawn. CMV antigen was found in herperipheral lymphocytes, and she had severe lymphopeniawith decreased CD4+ cells. At this time, her language wasnoted to be inappropriate for her age, and she developed arash on her face and abdomen, and unilateral facial palsy.PCR detected VZV in her cerebrospinal fluid.
The girl received aciclovir and corticosteroids. Sheimproved, with a negative VZV PCR, but her abdominalpain persisted. She received rituximab and then totalparenteral support. Her stomach lesions resolved but hercolonic lesions had minimal improvement. CMV wasdetected, and ganciclovir was initiated. After two furtherweeks, her colon lesions improved and she becamenegative for CMV antigen. At last follow-up she had nosymptoms; her CD4+ cell depletion was noted for18 months after antineoplastic withdrawal.
Author comment: "[N]o reports have described co-infection of these three herpes viruses together, as in thepresent case. Severe immunosuppression by intensivechemotherapy with craniospinal radiotherapy formedulloblastoma might have caused this."Ohta M, et al. Epstein-Barr virus-related lymphoproliferative disorder,cytomegalovirus reactivation, and varicella zoster virus encephalitis duringtreatment of medulloblastoma. Journal of Medical Virology 83: 1582-1584, No. 9,Sep 2011. Available from: URL: http://dx.doi.org/10.1002/jmv.22136 -Japan 803059100
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Reactions 20 Aug 2011 No. 13650114-9954/10/1365-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
