Successful treatment with matched unrelated donor peripheral blood stem cell transplantation for very severe aplastic anemia in presence of active infections: A case report.

RATIONALE: Very severe aplastic anemia (vSAA) with active infections is always fatal. Adequate infection control before hematopoietic stem cell transplantation is recommended. PATIENT CONCERNS: A 38-year-old woman with vSAA suffered from acute perforated appendicitis and invasive pulmonary fungal infection, and she failed to respond to intense antimicrobial therapies. DIAGNOSIS: She was diagnosed with refractory vSAA with stubborn acute perforated appendicitis and invasive pulmonary fungal infection. INTERVENTIONS: We successfully completed an emergent reduced intensity conditioning-matched unrelated donor (MUD)-peripheral blood stem cell transplantation (PBSCT) as a salvage therapy in the presence of active infections. The conditioning regimens consisted of reduced cyclophosphamide 30 mg/kg/day from day-5 to day-3, fludarabine 30 mg/m/day from day-5 to day-3 and porcine-antilymphocyte immunoglobulin 15 mg/kg/day from day-4 to day-2 without total body irradiation. Cyclosporin A, mycophenolate mofetil and short-term methotrexate were administered as graft-versus-host disease (GVHD) prophylaxis. Neutrophils and platelets were engrafted on day+15 and day+21. Appendiceal abscess and severe pneumonia developed after neutrophil engraftment, which were successfully managed with intense antimicrobial therapy and surgical intervention. OUTCOMES: Only limited cutaneous chronic GVHD was observed 5 months after transplantation. The patient still lives in a good quality of life 2 years after transplantation. LESSONS: Active infections may be no longer a contraindication to hematopoietic stem cell transplantation for some patients with vSAA.

Human parvovirus B-19: not just a pediatric problem.

Parvoviruses have long been associated with disabling and even fatal illnesses in animals. The discovery of the human parvovirus B-19 in 1975 (1) and subsequent studies of its effects in humans identified this virus as the causative agent of erythema infectiosum ("fifth disease") in children. (2). Erythema infectiosum (EI) is a common, self-limited infectious disorder in children, easily recognized by the classic "slapped cheek" facial erythema and fine reticular rash. Only in the 1980s have further investigations linked HPV B-19 infection with more significant clinical syndromes, among which is an adult polyarthropathy. This presentation in adults is more common than is currently understood and is easily confused with other symmetric polyarthropathies. Recognition and conservative treatment of this disorder are important for the emergency physician, to whom these patients may present.

Psoralen photoinactivation of herpes simplex virus: monoadduct and cross-link repair by xeroderma pigmentosum and Fanconi's anemia cells.

Furocoumarins (psoralen and its derivatives) are used to photoinactivate a variety of viruses and cell types. In the presence of long-wavelength ultraviolet light (UVA), furocoumarins bind covalently with pyrimidine residues via a cyclobutane ring. A second photoevent allows pyrimidines located on the opposite DNA strand in an adjacent base pair to react, forming a cross-link. In the experiments in this report, psoralen photoinactivation is employed to investigate human DNA repair pathways by analyzing the ability of xeroderma pigmentosum (XP) and Fanconi's anemia (FA) cells to rescue psoraleninactivated herpes simplex virus (HSV). Comparison of several XP complementation groups and one XP variant with normal human fibroblasts demonstrates that the ability of all cells to repair damage by 4,5',8-trimethylpsoralen (TMP), a derivative that forms cross-links efficiently, is similar. However, HSV photochemically reacted with 5-methylangelicin (5-MA), an isopsoralen that forms only monoadducts, is repaired at significantly lower levels in several XP complementation groups than in control fibroblast cells, which indicates that the XP repair deficiency resides in the removal of monoadducts and not of cross-links in these cell lines. Surprisingly, the FA cells rescue both TMP- and 5-MA-treated virus with slightly greater efficiency than that observed in normal human fibroblasts.