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H1N1 infection mimicking the clinical presentation of gastrointestinal GVHD in a patient following allo-SCT

Bone Marrow Transplantation volume 46, pages 152–153 (2011)Cite this article

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Four previous cases of H1N1 infection have been reported in patients following SCT.5, 6 In all four cases the patients presented with classic influenza-like symptoms, including fever, malaise and upper respiratory tract infection, and none of the reported patients had isolated GI symptoms. Our case represents the first report of isolation of the H1N1 virus from human GI tissue in association with abnormal histological findings on biopsy. At the time of biopsy the patient had isolated GI symptoms and no fever or upper respiratory tract symptoms. A PCR testing failed to identify the influenza virus from the upper respiratory track at the time of biopsy, ruling out the possibility of nasopharyngeal contamination during the stomach biopsy. Diarrhea, vomiting and abdominal pain are all common manifestations of GVHD flare-up in patients following allo-SCT. This case emphasizes the importance of GI biopsy in making the correct diagnosis. GI manifestation of H1N1 might precede the development of respiratory symptoms, and clinicians should have a high index of suspicion in post-transplant patients in the peak influenza season.

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Authors and Affiliations

  1. Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA

    H Frangoul, J Domm & C Calder

  2. Department of Infectious Diseases, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA

    M R Denison

  3. Department of Pathology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA

    J Black

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  1. H Frangoul
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  2. J Domm
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  3. M R Denison
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  4. C Calder
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Correspondence to H Frangoul.

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Frangoul, H., Domm, J., Denison, M. et al. H1N1 infection mimicking the clinical presentation of gastrointestinal GVHD in a patient following allo-SCT. Bone Marrow Transplant 46, 152–153 (2011). https://doi.org/10.1038/bmt.2010.66

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