RESUMO
Human metapneumovirus (hMPV) is a paramyxovirus that causes respiratory tract infections ranging from mild upper airway infection to severe pneumonia. Patients with haematological disease, especially haematopoietic stem cell transplantation (HSCT) recipients, are more likely to develop more severe infections. We describe three cases of hMPV infection in HSCT patients. The most reliable diagnostic procedure for hMPV is multiplex ligation-dependent probe amplification (MLPA) on a nasopharyngeal swab. Sensitivity and specificity of MLPA to detect hMPV is high and time to diagnosis is short. A number of other respiratory pathogens can be tested in one test run. Treatment is mainly supportive and only a few antiviral agents are available for treating paramyxovirus infections. Ribavirin and immunoglobulins were reported to be effective in cases of HSCT patients with hMPV pneumonia but their efficacy has not been studied in randomised trials.
Assuntos
Transplante de Células-Tronco Hematopoéticas , Hospedeiro Imunocomprometido/imunologia , Infecções por Paramyxoviridae/imunologia , Infecções Respiratórias/imunologia , Idoso , Antivirais/uso terapêutico , Feminino , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Leucemia Mieloide Aguda/terapia , Leucemia Plasmocitária/terapia , Masculino , Metapneumovirus/genética , Pessoa de Meia-Idade , Mieloma Múltiplo/terapia , Reação em Cadeia da Polimerase Multiplex , Nasofaringe/química , Infecções por Paramyxoviridae/diagnóstico , Infecções por Paramyxoviridae/terapia , RNA Viral/análise , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/terapia , Ribavirina/uso terapêutico , Sensibilidade e EspecificidadeRESUMO
We describe the case of a 65-year-old woman, known with ulcerative colitis, who presented with progressive headaches, haematomas and rectal bleeding which turned out to be the initial manifestation of disseminated intravascular coagulation (DIC) associated with colorectal cancer. The presentation posed as a general medicine case but turned out to be a rare oncological complication. The patient revealed possible carcinocythaemia and bone marrow infiltration with signet ring-like cells, as indicators of advanced adenocarcinoma. Treatment of the underlying disease resolved the DIC and contributed to prolonged survival. Subsequently, we reviewed the English literature since 1990 on similar cases and demonstrated that this association is extremely rare and is associated with a poor prognosis. Prompt recognition and treatment of the underlying disease is confirmed to be of utmost importance to prolong (progression-free) survival.