Summary:
A 55-year-old man with acute myeloid leukemia in second relapse presented 4 months after haploidentical CD34+-selected hematopoietic stem cell transplantation (HSCT) with symmetric, progressive neurological deficits of the lower extremities. Although there was no molecular evidence for drug resistance in the cerebral-spinal fluid, antiviral combination therapy failed to control the rapidly progressing CMV polyradiculopathy (PRP) and encephalitis, which were confirmed by autopsy studies. Late CMV PRP as an unusual manifestation of CMV disease should be kept in mind in patients with suggestive neurological symptoms after HSCT.
This is a preview of subscription content, access via your institution
Access options
Subscribe to this journal
Receive 12 print issues and online access
$259.00 per year
only $21.58 per issue
Rent or buy this article
Get just this article for as long as you need it
$39.95
Prices may be subject to local taxes which are calculated during checkout


References
Boeckh M, Riddel SR, Cunninham T et al. Increased incidence of late CMV disease in allogeneic marrow transplant recipients after ganciclovir prophylaxis is due to a lack of CMV specific T cell responses. Blood 1996; 88 (Suppl 1): 302a.
Seo SK, Regan A, Cihlar T et al. Cytomegalovirus ventriculoencephalitis in a bone marrow transplant recipient receiving antiviral maintenance: clinical and molecular evidence of drug resistance. Clin Infect Dis 2001; 33: 105–108.
Wolf DG, Lurain NS, Zuckerman T et al. Emerge of late cytomegalovirus central nervous system disease in hematopoietic stem cell transplant recipients. Blood 2003; 101: 463–465.
Anders HJ, Goebel FD . Cytomegalovirus polyradiculopathy in patients with AIDS. Clin Infect Dis 1998; 27: 345–352.
Cesaro S, Gazzola MV, Marson P et al. Successful engraftment and stable full donor chimerism after myeloablation with thiotepa, fludarabine, and melphalan and CD34-selected peripheral allogeneic stem cell transplantation in hemophagocytic lymphohistiocytosis. Am J Hematol 2003; 72: 143–146.
Meyer-König U, Serr A, Hufert FT et al. Laboratory diagnosis of HCMV-related disease in renal transplant patients – pp65 antigen detection vs nested PCR. Clin Diag Virol 1995; 3: 49.
Michel D, Höhn S, Haller T et al. Aciclovir selects for ganciclovir-cross-resistance of human cytomegalovirus in vitro that is only in part explained by known mutations in the UL97 protein. J Med Virol 2001; 65: 70–76.
Arribas JR, Storch GA, Clifford DB et al. Cytomegalovirus encephalitis. Ann Intern Med 1996; 125: 577–587.
Li CR, Greenberg PD, Gilbert MJ et al. Recovery of HLA-restricted cytomegalovirus (CMV)-specific T-cell responses after allogeneic bone marrow transplant: correlation with CMV disease and effect of ganciclovir prophylaxis. Blood 1994; 83: 1971–1979.
Boeckh M, Leisenring W, Riddell SR et al. Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood 2003; 101: 407–414.
Fletcher C, Sawchuk R, Chinnock B et al. Human pharmacokinetics of the antiviral drug DHPG. Clin Pharmacol Ther 1986; 40: 281–286.
Acknowledgements
CMV genotype analysis was done by Dr D Michel, University Hospital Ulm, Germany.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zeiser, R., GrĂ¼llich, C., Bertz, H. et al. Late cytomegalovirus polyradiculopathy following haploidentical CD34+-selected hematopoietic stem cell transplantation. Bone Marrow Transplant 33, 243–245 (2004). https://doi.org/10.1038/sj.bmt.1704311
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1038/sj.bmt.1704311
Keywords
- haploidentical
- CD34+-selected
- hematopoietic stem cell transplantation
- cytomegalovirus
- polyradiculopathy
This article is cited by
-
A fatal case of cytomegalovirus ventriculoencephalitis in a mycosis fungoides patient who received multiple umbilical cord blood cell transplantations
International Journal of Hematology (2012)
-
CMV central nervous system disease in stem-cell transplant recipients: an increasing complication of drug-resistant CMV infection and protracted immunodeficiency
Bone Marrow Transplantation (2010)