mercaptopurine and Cytomegalovirus-Infections

Topics: Anemia, Sickle Cell; Antibodies, Monoclonal; Antiviral Agents; Child; Crohn Disease; Cytomegalovirus; Cytomegalovirus Infections; Fatal Outcome; Ganciclovir; Gastrointestinal Agents; Humans; Immunosuppressive Agents; Infliximab; Male; Mercaptopurine

A 28-year-old woman with acute lymphoblastic leukemia developed fever and unilateral pleural based pulmonary infiltrate during prolonged chemotherapy induced neutropenia. CT-guided lung biopsy confirmed the diagnosis of pulmonary mucormycosis and liposomal amphotericin B therapy was started. A few days after the initial symptoms, the patient developed convulsions and a brain abscess was detected in computerized tomography and magnetic resonance imaging. Fungal hyphae detected in histopathological examination of a brain biopsy had identical morphology with those seen in previous lung biopsies. The patient was treated with liposomal amphotericin B for five months and cytotoxic chemotherapy was successfully completed during antifungal therapy. Pulmonary infiltrates and the brain abscess resolved and the patient received an allogeneic bone marrow transplantation from a matched, unrelated donor. Antifungal therapy was continued for one additional month after bone marrow transplantation to prevent a relapse of invasive mucormycosis. Follow-up of the patient revealed no signs of relapse of invasive mucormycosis but two months after successful bone marrow transplantation the patient developed lethal cytomegalovirus pneumonitis which was confirmed by autopsy. No signs of mucormycosis were detected at post-mortem.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bone Marrow Transplantation; Brain Abscess; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Cytomegalovirus Infections; Daunorubicin; Dexamethasone; Etoposide; Fatal Outcome; Female; Humans; Immunocompromised Host; Liposomes; Lung Diseases, Fungal; Mercaptopurine; Mitoxantrone; Mucormycosis; Pneumonia, Viral; Postoperative Complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Transplantation, Homologous; Vincristine

6-mercaptopurine (6-MP) and azathioprine are important drugs for the treatment of inflammatory bowel disease (IBD) but their actions suppress host defense against infection. A challenging case of a 19-year-old female patient with quiescent Crohn's disease maintained with 6-MP presenting with dyspnea and a normal chest exam and x-ray is presented. She became ventilator-dependent and only after numerous investigations was diagnosed with cytomegalovirus (CMV) pneumonitis. A systematic literature review of CMV infections in IBD patients was performed. The present case is the first report of a patient with quiescent IBD maintained on 6-MP who developed CMV pneumonitis. Other reports have identified patients with active disease on multiple immunosuppressants who developed CMV pneumonitis and also highlight the risk of CMV colitis in refractory IBD. The authors review the approach to the diagnosis of CMV infections in IBD patients with atypical pneumonia and colitis and highlight the importance of considering CMV infection in these settings.

Topics: Adult; Crohn Disease; Cytomegalovirus; Cytomegalovirus Infections; Diagnosis, Differential; Female; Humans; Immunosuppressive Agents; Mercaptopurine; Pneumonia, Viral; Respiration, Artificial

Topics: Animals; Cytomegalovirus Infections; Female; Immunity; Mercaptopurine; Mice; Mice, Inbred Strains

Topics: Age Factors; Asparaginase; Chickenpox; Child, Preschool; Counseling; Cyclophosphamide; Cytarabine; Cytomegalovirus Infections; Daunorubicin; Drug-Related Side Effects and Adverse Reactions; Humans; Injections, Spinal; Leukemia; Mercaptopurine; Methotrexate; Patient Care Planning; Pediatrics; Physician-Patient Relations; Prednisone; Prognosis; Sex Factors; Vincristine

Topics: Adolescent; Adult; Asparaginase; Blood Transfusion; Bone Marrow Transplantation; Child; Cyclophosphamide; Cytarabine; Cytomegalovirus Infections; Daunorubicin; Female; Graft vs Host Reaction; Histocompatibility Testing; Humans; Immunosuppressive Agents; Leukemia, Lymphoid; Male; Mercaptopurine; Methotrexate; Prednisolone; Remission, Spontaneous; Vincristine

Topics: Anti-Bacterial Agents; Child; Cytomegalovirus Infections; Female; Humans; Leukemia; Male; Mercaptopurine; Pneumonia, Viral