P187 Cryptococcal neuroinfection in an adult patient with chronic B-lymphatic leukaemia with medium risk: A case report

✍ Scribed by L. Slovacek; L. Jebavy; V. Pavlik; B. Slovackova; Z. Macingova

• Publisher: Elsevier Science
• Year: 2007
• Tongue: English
• Weight: 50 KB
• Volume: 21
• Category: Article
• ISSN: 0268-960X
• DOI: 10.1016/s0268-960x(07)70266-7

✦ Synopsis

Introduction: Liver complications are a major cause of morbidity and mortality following haematopoietic stem cell transplantation (HSCT). However, fulminat hepatic failure (FHF) due to herpes simplex virus-1 (HSC-1) as a late complication in HSCT recipients is very rare. Material and Methods: We present a case of HSV-1 acute FHF 20 years after allogeneic-HSCT. Results: A 41-year-old female with acute myeloid leukemia underwent allogeneic bone marrow transplantation from HLAidentical brother in 1986. The patient showed grade 2 acute skin graft versus host disease (GVHD) and her chronic GVHD belonged to the extensive type. Two years after HSCT, the patient not required immunosuppressive therapy for chronic GVHD. Twenty years after the allogeneic-HSCT, the patient was admitted to Hospital on June, 2006, with fever, malaise, bloody diarrhea, mild right abdominal pain and hepatomegaly. Full blood count revealed pancytopenia and liver function tests showed elevated liver enzymes. However, her liver function tests worsened. From eigth day after admission, she died of acute fulminant hepatitis and multiorgan failure. The autopsy histologic features were consistent with atrophia flava. Polymerase chain reaction (PCR) testing of her serum and autopsy liver tissue subsequently confirmed HSV-1 DNA. The clinical, histologic and PCR test results corresponding to the HSV-1 FHF. Conclusion: HSV-1 hepatitis should be considered when recipients of HSCT develop abdominal pain, fever and elevation in liver function tests. The literature is reviewed and the role of rapid viral diagnosis is discussed.

P187 Cryptococcal neuroinfection in an adult patient with chronic B-lymphatic leukaemia with medium risk: A case report