Abstract
Virus-associated hemophagocytic syndrome (VANS) has been linked most commonly to herpes group viruses. It has not previously been reported in a bone marrow transplant (BMT). VAHS occurred in a 5 y/o girl who underwent an autologous BMT for metastatic Wilms tumor. Prior to BMT she received doxorubicin, high dose melphalan, and local radiation to her chest and abdomen. Adenovirus was isolated consistently throughout the course of the transplant from urine and stool, but not from buffy coats or respiratory tract secretions. Bone marrow exam (BME) 2 wks post BMT showed hematopoietic recovery with all three cell lines present. At +4 wks she developed hepatomegaly with elevated liver enzymes, intermittent fever and pancytopenia. BME at that time was hypocellular with marked histiocyte phagocytosis of immature and mature red cells, white cells and platelets. The histiocytes were mature with abundant vacuolated cytoplasm and inconspicuous nucleoli. A BME at +7 wks showed prominent histiocytes and hemophagocytosis and aplasia of all hematopoietic cells. A culture of this marrow grew adenovirus. Nine wks after BMT she developed fatal interstitial pneumonia. Cultures of pleural fluid and lung tissue from open lung biopsy grew adenovirus. Post mortem cultures from lung, heart, spleen and GI tract grew adenovirus. This is the first case of culture proven adenovirus VAHS in a BMT patient.
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Wodell, R., Gupta, R., Bayever, E. et al. 950 ADENOVIRUS ASSOCIATED HEMOPHAGOCYTIC SYNDROME IN A BONE MARROW TRANSPLANT PATIENT. Pediatr Res 19, 269 (1985). https://doi.org/10.1203/00006450-198504000-00980
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DOI: https://doi.org/10.1203/00006450-198504000-00980