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Sequential respiratory syncytial virus and cytomegalovirus pneumonia following bone marrow transplantation
J Kapelushnik1, D Engelhard, J Mehta
1Department of Bone Marrow Transplantation, Hadassah University Hospital, Jerusalem, Israel.
Insights
A bone marrow transplant patient with familial hemophagocytic lymphohistiocytosis (FHL) developed severe pneumonia from respiratory syncytial virus (RSV) and cytomegalovirus (CMV) due to deficient natural killer (NK) cell activity. Early diagnosis and treatment are crucial for managing these life-threatening infections.
Area of Science:
- Pediatric Hematology
- Immunology
- Infectious Diseases
Background:
- Familial hemophagocytic lymphohistiocytosis (FHL) is a rare, life-threatening condition of immune dysregulation.
- Bone marrow transplantation (BMT) is a curative treatment for FHL but carries risks of infection and immune complications.
- Patients with FHL often have deficiencies in natural killer (NK) cell activity, impacting immune surveillance.
Observation:
- A 6-month-old infant with FHL developed sequential pneumonia post-BMT.
- The infections were caused by respiratory syncytial virus (RSV) and cytomegalovirus (CMV).
- The patient exhibited deficient NK cell activity, a common characteristic of FHL.
Findings:
- Deficient NK cell activity likely contributed to the susceptibility to concurrent RSV and CMV infections.
- The early and sequential nature of these viral pneumonias highlights a critical post-BMT vulnerability.
- Concomitant viral infections pose a significant threat in immunocompromised pediatric patients.
Implications:
- Rapid diagnostic methods for RSV and CMV are essential in post-BMT FHL patients.
- Prompt, specific antiviral therapies may mitigate severe lung injury from these pathogens.
- Understanding NK cell deficiency is key to preventing and managing severe infections in FHL.
Abstract:
A 6-month-old child with familial hemophagocytic lymphohistiocytosis (FHL) experienced early sequential pneumonia due to respiratory syncytial virus (RSV) and cytomegalovirus (CMV) following bone marrow transplantation (BMT). The patient was deficient in natural killer (NK) cell activity (as found frequently in patients with FHL), and this risk factor may have played a major role in the concomitant infection by the two viral pathogens. Rapid diagnostic methods for both viruses are essential and early specific treatment may serve to ameliorate RSV- and CMV-induced lung injury in these life-threatening infections.