Severe Disseminated Adenovirus Infection After Haploidentical Hematopoietic Stem Cell Transplantation: A Case Report.

Abstract

BACKGROUND Adenoviruses are double-stranded DNA viruses capable of causing a spectrum of diseases from mild respiratory infections to severe systemic illnesses. Disseminated adenovirus is evidenced by gastrointestinal, pulmonary, genitourinary, neurologic and even cardiac involvement. In immunocompromised individuals, adenovirus infections can become severe and are often associated with significant morbidity and mortality. CASE REPORT A 52-year-old man with a history of large granular lymphocytic (LGL) leukemia underwent haploidentical hematopoietic stem cell transplantation (HSCT). His course was complicated by the diagnosis of hemorrhagic cystitis with findings of adenovirus. His condition rapidly declined, necessitating Intensive Care Unit (ICU) admission. Comprehensive workup identified adenovirus in the serum and cerebrospinal fluid (CSF), bronchoalveolar lavage fluid, and positive stool adenovirus. Echocardiographic evaluation revealed a moderate pericardial effusion requiring pericardiocentesis. Unfortunately, adenovirus testing of the aspirate could not be performed. Given the diagnosis of disseminated adenovirus infection, treatment with cidofovir and probenecid was initiated, but despite these interventions, the patient's status continued to deteriorate complicated by multiorgan failure and refractory shock. CONCLUSIONS This case underscores the complexity of diagnosing disseminated adenovirus, particularly given the potential for multiorgan system involvement. Early recognition is essential, such as viral polymerase chain reaction (PCR), playing a critical role in the identification and monitoring of infection. The case further emphasizes the pressing need for continued research into novel antiviral therapies and preventive measures to mitigate the risk of adenovirus in this vulnerable population.