Abstract
A child who received a second bone marrow transplant 3 weeks ago as part of treatment for relapsed leukemia has developed fever along with low grade mucositis. The child has been on an acyclovir prophylaxis regimen. Viral culture of an oral specimen has grown herpes simplex virus (HSV) type 1. Serum quantitative polymerase chain reaction tests for cytomegalovirus (CMV) show a 2-log increase in viral load after onset of fever compared with 2 weeks prior. The Hematology-Oncology fellow who calls you for a consult expresses that, in addition to the CMV issue, there is concern that the HSV isolate may be resistant to acyclovir.
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