mercaptopurine and Viremia

Parvovirus B19 is a small single-stranded DNA virus of the Parvoviridae family. Depending on host factors, it may produce a wide array of clinical disease states. Disease severity can range from self-limited to severe, requiring significant supportive care. Immunocompromised patients are generally affected more severely but rarely develop prolonged and persistent infections. Here, we describe a patient who was diagnosed with parvovirus during maintenance therapy for acute lymphoblastic leukemia and required therapy with intravenous immunoglobulin; the patient remained parvovirus positive according to a polymerase chain reaction testing but had no clinical symptoms for 27 months off chemotherapy.

Topics: Antineoplastic Agents; Asymptomatic Infections; Child; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Immunosuppressive Agents; Male; Mercaptopurine; Methotrexate; Parvoviridae Infections; Parvovirus B19, Human; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Viremia

Disseminated adenoviral infection with hepatitis is rare in children undergoing standard chemotherapy. We report on a 3(1/2)-year-old male with fatal adenovirus hepatitis receiving maintenance chemotherapy for acute lymphoblastic leukemia (ALL). Adenoviral hepatitis was proven by histology, viral culture, and PCR in a liver biopsy. Quantitative real-time PCR in the peripheral blood showed adenoviral DNA copy number >10(9)/ml. Despite aggressive supportive care and antiviral treatment with cidofovir, the patient died rapidly due to fulminant liver failure. Diagnostic and treatment options for adenovirus infection remain unsatisfactory for these patients. We propose suggestions for diagnosis and therapy.

Topics: Adenovirus Infections, Human; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Asparaginase; Child, Preschool; Cidofovir; Computer Systems; Cytosine; DNA, Viral; Fatal Outcome; Hepatitis, Viral, Human; Humans; Immunocompromised Host; Male; Mercaptopurine; Methotrexate; Multiple Organ Failure; Organophosphonates; Polymerase Chain Reaction; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Vincristine; Viremia