Late cytomegalovirus infection after hematopoietic stem cell\ntransplantation: case reports
A 50-year-old female patient underwent unrelated allogeneic HSCT after diagnosis of\nmyelodysplastic syndrome (refractory anemia with excess blasts II). The pre-transplant\nserostatus for CMV indicated D+R+. Fludarabine, busulfan and\nanti-thymocyte globulin (ATGAM) were used in the conditioning regimen. On D+79,\ncutaneous and gastrointestinal tract GVHD was diagnosed and confirmed by duodenal\nbiopsy. At this time, tacrolimus and methylprednisolone were introduced. The patient had\nfever and CMV antigenemia as shown by 29 positive cells/200,000 leukocytes only on D+180\n(). Therapy with intravenous\nganciclovir (5 mg/kg/dose) for 14 days was introduced immediately and ambulatory\ntreatment continued for seven days with ganciclovir (200 mg/day). The antigenemia became\nnegative on D+201. At D+229, the patient developed mild fever and the CMV antigenemia\nwas two positive cells/200,000 leukocytes (). Due to the low value of antigenemia and spontaneous resolution of the\nfever, antiviral therapy was not initiated. On D+236, the CMV antigenemia was negative\nand remained so until D+257. On D+995, the patient had liver, gastrointestinal and\nocular GVHD.