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West Nile Virus encephalopathy in an allogeneic stem cell transplant recipient: use of quantitative PCR for diagnosis and assessment of viral clearance

Bone Marrow Transplantation volume 36, pages 369–370 (2005)Cite this article

A 50-year-old woman who lived in St Louis, Missouri received a mismatched unrelated bone marrow transplant (BMT) in January 2003 for CML in accelerated phase. She had persistent evidence of disease by cytogenetic analysis but remained relatively stable while on imatinib therapy. She had chronic skin GVHD but was off all immunosuppression at the time of her clinical presentation in August 2004 when she presented with fatigue, fever and shortness of breath. She denied any recent travel history or exposure to insect bites at the time of admission. She had clinical features of cardiac tamponade and rapidly became unstable, requiring intubation and performance of an emergent pericardial window. Bacterial, fungal and mycobacterial cultures from the pericardial fluid were negative and pathology revealed a fibrinous pericarditis. She also developed encephalopathy, seizures and flaccid quadriplegia. An MRI of the brain and cervical spine was performed which revealed no abnormalities. A lumbar puncture was performed and revealed an elevated protein of 162 with 180 nucleated cells. Cytology from the CSF did not reveal any blasts. CSF RT-PCR for WNV was positive at 770 Copies/ml. CSF was also positive for EBV by PCR, but HSV, enterovirus and toxoplasmosis were all negative by PCR analysis.

Peripheral blood was also sent to detect WNV. Testing for WNV RNA was performed using a commercial real-time reverse transcription PCR assay (Artus Biotech, San Francisco, CA, USA) performed on a Roche Light Cycler. The assay used amplifies a segment of the 5′ untranslated regions of the viral genome. WNV IgM ELISA was positive on 8/24/04 and 10/19/04 and WNV PCR was 5.1 × 106 Copies/ml from 8/26/04 and 4.0 × 106 Copies/ml from 10/21/04. EBV was also detected in multiple blood samples by PCR with a maximum dilution varying from 1:1000 to 1:10. CMV, enterovirus and HHV-6 were all negative in the serum by PCR analysis.

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Acknowledgements

We acknowledge Marcus Hess, artus GmbH, Germany for performing the West Nile Virus RT-PCR tests on specimens from December to January.

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Authors and Affiliations

  1. Section of Bone Marrow Transplantation and Leukemia, Washington University School of Medicine, St Louis, MO, USA

    W Brenner, R Vij, S Devine & J DiPersio

  2. Department of Pediatrics, St Louis Children's Hospital, St Louis, MO, USA

    G Storch & R Buller

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  1. W Brenner
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  2. G Storch
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Brenner, W., Storch, G., Buller, R. et al. West Nile Virus encephalopathy in an allogeneic stem cell transplant recipient: use of quantitative PCR for diagnosis and assessment of viral clearance. Bone Marrow Transplant 36, 369–370 (2005). https://doi.org/10.1038/sj.bmt.1705059

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