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Cytomegalovirus meningitis in a patient with relapsed acute myeloid leukemia

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Abstract

Cytomegalovirus meningitis/meningoencephalitis is a potentially fatal complication following hematopoietic stem cell transplantation that causes significant morbidity and mortality. In the pre-transplant setting, a few cases involving lymphoid malignancies have been reported. However, there have been no reports of patients with myeloid malignancies. A 36-year-old man with relapsed acute myeloid leukemia received high-dose cytarabine-containing salvage chemotherapies and then developed grade 4 lymphopenia for more than one month. Subsequently, the patient developed pyrexia, accompanying headache, nausea, and vomiting with no abnormal brain imaging. Despite receiving antimicrobial treatment, his febrile status and headache persisted. Given that the patient had symptoms consistent with viral meningitis with no evidence of etiology other than positive cytomegalovirus-DNA in his cerebrospinal fluid and cytomegalovirus pp65 antigenemia, cytomegalovirus meningitis was diagnosed. After commencing ganciclovir treatment, the patient’s headache and febrile status rapidly improved. Cytomegalovirus meningitis/meningoencephalitis is rare before hematopoietic stem cell transplantation, but may be useful in differential diagnoses in heavily treated acute myeloid leukemia patients with central nervous system symptoms.

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Acknowledgements

The authors are grateful to the staff of the Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, for their excellent patient care.

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Authors and Affiliations

  1. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan

    Kaito Harada, Shuntaro Ikegawa, Takeshi Kobayashi & Kazuteru Ohashi

  2. Department of Infection Prevention and Control, Department of Clinical Laboratory, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 1138677, Japan

    Noritaka Sekiya & Shugo Sasaki

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  1. Kaito Harada
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  2. Noritaka Sekiya
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  3. Shuntaro Ikegawa
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Correspondence to Noritaka Sekiya.

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Harada, K., Sekiya, N., Ikegawa, S. et al. Cytomegalovirus meningitis in a patient with relapsed acute myeloid leukemia. Int J Hematol 109, 233–238 (2019). https://doi.org/10.1007/s12185-018-2544-x

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  • DOI: https://doi.org/10.1007/s12185-018-2544-x

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