RESUMEN
Resistant and refractory cytomegalovirus (CMV) viremia can limit the provision of chemotherapy due to myelosuppression and end-organ dysfunction. Few therapies are available for children with clinically significant CMV viremia. We successfully used maribavir for a 4-year-old patient with lymphoma to complete his chemotherapy course. Resistance to maribavir did result after many months of therapy.
Asunto(s)
Infecciones por Citomegalovirus , Diclororribofuranosil Benzoimidazol , Neoplasias , Ribonucleósidos , Preescolar , Humanos , Antivirales/uso terapéutico , Bencimidazoles/uso terapéutico , Infecciones por Citomegalovirus/tratamiento farmacológico , Diclororribofuranosil Benzoimidazol/análogos & derivados , Neoplasias/tratamiento farmacológico , Ribonucleósidos/uso terapéutico , Viremia/tratamiento farmacológicoRESUMEN
We describe the case of an infant who presented with simple rhinovirus/enterovirus bronchiolitis whose condition worsened with rapid progression to multiple organ dysfunction syndrome (MODS). The patient was presumed to have either primary or secondary hemophagocytic lymphohistiocytosis (HLH), and treatment was initiated using dexamethasone, anakinra, and intravenous immunoglobulin to modulate the immune system. Due to the organ dysfunction, the use of etoposide was avoided and instead, emapalumab, an interferon gamma antagonist, was administered at a dose of 6â mg/kg. The patient's organ failure improved, and the levels of inflammatory markers decreased. The flow cytometry analysis revealed that cytotoxic cells lacked perforin expression, and subsequent genetic analysis confirmed homozygous pathogenic mutations in the perforin gene. This case highlights the potential avoidance of etoposide in cases of primary HLH, the possible benefit of an elevated initial dose of emapalumab, and the contribution offered by a multi-specialty team approach to complex diagnosis.