Abstract
Cytomegalovirus (CMV) central nervous system disease after hematopoietic stem cell transplantation (HSCT) is a rare but life-threatening complication. Here, we report a patient who developed CMV meningitis after HSCT and was treated with the combination therapy of intrathecal high-titer CMV immunoglobulin and antiviral drugs. A 38-year-old man with myelodysplastic syndrome received a cord blood transplant after graft failure. On day 147, he was diagnosed with CMV meningitis based on pleocytosis and CMV DNA in the cerebrospinal fluid (CSF). Intravenous ganciclovir, foscarnet, and immunoglobulin were administered; however, CMV DNA in the CSF was continuously detected. The addition of intrathecal high-titer CMV immunoglobulin resulted in CMV DNA in the CSF becoming undetectable. On day 241, CMV DNA in the CSF was detected again, but both intrathecal immunoglobulin and intravenous ganciclovir led to its disappearance. No adverse effects related to intrathecal administration were observed. The intrathecal administration of immunoglobulin may be safe and effective for CMV meningitis.
Highlights
CMV disease is still one of the most serious complications after hematopoietic stem cell transplantation (HSCT)
Immunoglobulin available in Japan can be categorized into two types: incomplete and complete
Intrathecal administration of the incomplete type has been approved in Japan
Summary
CMV disease is still one of the most serious complications after HSCT. By preemptive therapy against CMV reactivation, CMV disease has been successfully reduced during the first several months after HSCT. Late-onset CMV disease after the completion of monitoring the viral load is frequently observed in high-risk patients [1]. CMV central nervous system (CNS) disease developing at such a stage has rarely been reported [2, 3]. The occurrence of CMV CNS disease is associated with high mortality due to impaired CMV-specific immunity, antiviral drug resistance, or both [2]. New therapeutic strategies for CMV CNS disease are needed
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