<CBC> <biochemistry> <others> WBC /l CRP.mg/dl CMV AG /WBC Nuet.. TP.g/dl Eos.. Alb.g/dl CDcell./l Baso.. BUN mg/dl CDcell./l Mono.. Cr.mg/dl CD/. Lym
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1 HLA Grade reduced-intensity stem cell transplantation RIST T adult T-cell leukemia ATL RIST graftversus-host diseasegvhd ATL cytomegalovirus CMV RIST cytomegalovirus retinitis CMVR ATL B HTLV- / l. HTLV- DNA
2 <CBC> <biochemistry> <others> WBC /l CRP.mg/dl CMV AG /WBC Nuet.. TP.g/dl Eos.. Alb.g/dl CDcell./l Baso.. BUN mg/dl CDcell./l Mono.. Cr.mg/dl CD/. Lymp.. T. Bil.mg/dl IgG mg/dl RBC /l AST/ALT /IU/l IgA mg/dl Hb.g/dl LDH IU/l IgM mg/dl Ht. sil-r U/ml Plt.. /l Ret. ATL prednisolone PSLmg/day CMV CMV CMV-DNA /ml CMV ganciclovirgcvmg/day LSG- HLA ABO HTLV- HBs RIST fludarabine mg/m busulfan mg/kg total body irradiationtbi Gy GVHD methotrexate ciclosporincsa. /kg day.stage GVHD Grade PSL mg/day mg/kg/day GVHD PSLmg/day day CMV GCV foscarnet foscarnet G-CSF CMVR day.cm.kg. GVHD Table WBC /lrbc /lhb.g/dlplt. /l CRP.mg/dl LDH IU/l G-CSF IL-R U/ml GVHD IgG mg/ dliga mg/dligm mg/dlcd /l CD /lcd/. CMV Fig. CMVR
3 right left Figure 1 Fundus appearance on admission Funduscopy of the day of onset. Paravascular whitish infi ltrates with multiplehemorrhages can be seen. Fig. foscarnet g/day mg/kg/day CMV CMV-DNA foscarnet GCV mg/day fig. valganciclovir mg/dayday GCV G-CSF GCV foscavir GCV valganciclovir chemothrapy BMT CMV colitis CMV retinitis /μl AG:4/58/20/08/110/08/310/09/264/310/270/012/6 lymphocyte H H H H H H H H H Figure 2 clinical course
4 right left Figure 3 clinical course of fundus fi nding Athe day of onset. Bone month after treatment. a few hemorrhages and exudates are still present. Cthree months later. a few hemorrhages are still present, but exudates and edema improved. CMVR CMV CMV ATL CMVR CMVR acquired immunodeficiency syndrome AIDS hematopoietic stem cell transplantation HSCT. AIDS CMVR CD T HIV BRB BRB CMV CMVR HTLV-/ATL CMVR ATL CMVR ATL HSCT ATL CMVR HSCT CMVR CMV day PCR CD/l GVHD
5 GVHD RIST foscarnet viremia CMVR HTLV- HIV HTLV- CMVR CMV PCR CMV CMVR foscarnet CMV-DNA CMVR PCR DNA CMVR QOL NASBA CMV mrna CMVR PCR GCV CMV CMV - T - Pertel P, et al.: Risk of developing cytomegalovirus retinitis in persons infected with the human immunodeficiency virus. J Acquir Immune Defic Syndr. : -, Gallant JE, et al.: Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group. J Infect Dis. : -, Paul Ng, et al.: Ocular complications of heart, lung, and liver transplantation. Br J Ophthalmol. : -, Guembel HO, Ohrloff C. : Opportunistic infections of the eye in immunocompromised patients. Ophthalmologica. Suppl : -, Crippa F, et al.: Virological, clinical, and ophthalmologic features of cytomegalovirus retinitis after hematopoietic stem cell transplantation. Clin Infect Dis. : -, Glasgow BJ: Evidence for breaches of the retinal vasculature in acquired immune deficiency syndrome angiopathy. A fluorescent microsphere study. Ophthalmology. : -, Glasgow BJ, Weisberger AK: A quantitative and cartographic study of retinal microvasculopathy in acquired immunodeficiency syndrome. Am J Ophthalmol. : -, Junghanss C, et al: Incidence and outcome of cytomegalovirus infections following nonmyeloablative compared with myeloablative allogenic stem cell transplantation, a matched control study. Blood. : -,
6 Nakao K, Ohba N: Human T-cell lymphotropic virus type -associated retinal vasculitis in children. Retina. : -, Merle H, et al: Retinal vasculitis caused by adult T-cell leukemia/lymphoma. Jpn J Ophthalmol. : -, Weinberg A, et al: Comparison of PCR, Antigenemia Assay, and Rapid Blood Culture for Detection and Prevention of Cytomegalovirus Disease after Lung Transplantation. J Clin Microbiol. : -, Solano C, et al: Qualitative plasma PCR assay AMPLICOR CMV Testversus pp antigenemia assay for monitoring cytomegalovirus viremia and guiding preemptive ganciclovir therapy in allogeneic stem cell transplantation. J Clin Microbiol. : -, Ohta H, et al: Foscarnet therapy for ganciclovir-resistant cytomegalovirus retinitis after stem cell transplantation: effective monitoring of CMV infection by quantitative analysis of CMV mrna. Bone Marrow Transplant. : -,
7 Jichi Medical University Journal CYTOMEGALOVIRUS RETINITIS IN AN ADULT T-CELL LEUKEMIA PATIENT AFTER REDUCED-INTENSITY HEMATOPOIETIC STEM CELL TRANSPLANTATION Raine Tatara, Masaki Mori, Shin-ichiro Fujiwara, Takuji Miyoshi, Kazuya Sato, Chizuru Kawano-Yamamoto, Tomohiro Matsuyama, Masaki Toshima, Ken Ohmine, Katsutoshi Ozaki, Masaaki Takatoku, Tadashi Nagai, Keiya Ozawa, Kazuo Muroi Abstract A -year-old female was admitted for acute type adult T-cell leukemia in October,. She developed CMV enterocolitis after treatment with prednisolone PSLfor ATL eruption, and was then treated with ganciclovir and progressing favorably. She achieved complete remission through the LSG- protocol without PSL. She, therefore, received bone marrow transplantation with a reduced intensityconditioning regimen from an HLA-matched sibling donor in March,. We started medication with PSL and ciclosporin A CSAfor acute skin GVHD grade, but both immunosuppressive therapies were needed for several weeks because we could not control it. When she noted blurring of vision in both eyes and narrowing of the visual field, CMV had been reactivated, and funduscopic examination revealed paravascular whitish infiltrates with multiple hemorrhages in both eyes. Based on these finding, we diagnosed her to have CMV retinitis. Although she was treated with foscarnet and her antigenemia became negative, her retinitis progressed. Finally, her retinitis improved due to the induction of ganciclovir. Reports on CMV retinitis after stem cell transplantation are few, therefore further accumulation of such cases is needed to further define the correct management. Division of Cell Therapy, Jichi Medical University Department of Hematology, Osaka Medical College
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