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A case of ‘red eye’ post allogeneic stem cell transplantation

Bone Marrow Transplantation volume 39, pages 241–242 (2007)Cite this article

The patient was initially treated symptomatically with artificial tears and lubricants but failed to improve with this conservative approach. Reduction of immunosuppression was not feasible due to risks of graft versus host disease. Treatment with intravenous cidofovir 1 mg/kg was eventually instituted 11 days after the initial presentation. Cidofovir was given three times a week for a period of 4 weeks (total of 12 doses). This resulted in rapid clinical improvement and the patient was successfully discharged.

Adenoviruses are non-enveloped, lytic DNA viruses. There are 51 known subtypes capable of infecting humans.1, 2 Keratoconjunctivitis is a rare but recognized complication of adenoviral infection and cases are specifically associated with subgroup D viruses. Reported rates of adenoviral infection posthaematopoietic stem cell transplantation vary from 5 to 32% depending on methods of viral detection used.1 Risk factors for infection in this group include age (with children more likely to be affected than adults), adenovirus antibody positivity in the donor, unrelated or HLA mismatched allografts, total body irradiation and T-cell depletion.2 Antiviral treatments for adenoviral infections and the evidence for their efficacy in vivo is limited. Cidovovir has been shown to have in vitro activity against all adenoviral serotypes3 and data suggests an antiviral effect in certain treated individuals.4 In contrast, Ribavirin appears to have in vitro activity primarily against subgroup C viruses3 and this factor may contribute to the limited data supporting the antiviral efficacy of Ribavirin in vivo.5 In addition to existing antiviral strategies, adoptive immunotherapy using cytotoxic adenovirus-specific T-cells may be a promising future therapeutic alternative.1, 2, 6

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  1. Department of Haematology, Royal Free Hospital, London, UK

    A Castleton & P D Kottaridis

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Correspondence to P D Kottaridis.

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Castleton, A., Kottaridis, P. A case of ‘red eye’ post allogeneic stem cell transplantation. Bone Marrow Transplant 39, 241–242 (2007). https://doi.org/10.1038/sj.bmt.1705568

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