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CMV-induced hemorrhagic cystitis as a complication of peripheral blood stem cell transplantation: case report

Bone Marrow Transplantation volume 36, pages 265–266 (2005)Cite this article

Cytomegalovirus (CMV) disease is a major cause of morbidity and mortality after hematopoietic stem cell transplantation. Despite preemptive therapy, the incidence of early and late CMV disease remains as high as 15% in stem cell transplant patients1 and late CMV reactivation occurs in 18% of CMV-seropositive recipients who discontinue preemptive therapy for CMV.2 The most common presentation of CMV disease in transplant patients is CMV- pneumonitis, followed by gastrointestinal CMV disease.2 Also, reports of late CMV infections in unusual sites such as the central nervous system and eyes are being increasingly recognized.3, 4 CMV-induced hemorrhagic cystitis (HC) in transplant patients is uncommon. To our knowledge, in the literature there is only one reported case of CMV-induced HC in a patient after allogeneic bone marrow transplantation (BMT).5 In this report, we describe a patient who developed CMV-induced HC 15 days after a matched unrelated donor peripheral blood stem cell transplantation (MUD PBSCT). To our best knowledge, this is the first report of CMV-induced HC after peripheral blood stem cell transplantation.

The patient was a 46-year-old male with a history of chronic myelogenous leukemia (CML) for 3 years. He was initially treated with hydroxyurea, alpha interferon and Ara-C with good response. He was in remission for 2 years. He was then noted to have an increasing leukocytosis. A bone marrow (BM) biopsy was consistent with accelerated phase of CML based on an increased number of blasts. He was started on Imatinib Mesylate. One month later, he was in morphological remission, but cytogenetic analysis was still positive for the Philadelphia chromosome. Subsequently, a MUD PBSCT was performed following standard conditioning with Busulfan (1 mg / kg q6h, 16 doses) and Cytoxan (60 mg / kg / day for 2 days). Both the patient and donor were CMV seropositive. GVHD prophylaxis-included ATG (2.5 mg / kg for 4 days), Methotrexate (5 mg / m2 at 1st, 3rd, 6th and 11th days) and Tacrolimus (targeted at approximately 10 ng / ml).

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Authors and Affiliations

  1. Department of Pathology, Lombardi Cancer Center, Georgetown University Hospital, Washington, DC, USA

    S O Tutuncuoglu & M Ozdemirli

  2. Department of Hematology / Oncology, Lombardi Cancer Center, Georgetown University Hospital, Washington, DC, USA

    S Yanovich

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  1. S O Tutuncuoglu
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Tutuncuoglu, S., Yanovich, S. & Ozdemirli, M. CMV-induced hemorrhagic cystitis as a complication of peripheral blood stem cell transplantation: case report. Bone Marrow Transplant 36, 265–266 (2005). https://doi.org/10.1038/sj.bmt.1705030

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