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Disseminated cerebral adenovirus endotheliitis: case report A 60-year-old man developed disseminated cerebral adenovirus endotheliitis while receiving bortezomib to prevent the relapse of multiple myeloma, and mycophenolate-mofetil, prednisone and tacrolimus for the treatment of acute graft versus host disease (GvHD) [not all routes and dosages stated]. The man, who initially presented in 2014 due to progressive back pain, was diagnosed with stage II/III de novo κ-light chain multiple myeloma. Subsequently, he received 4 cycles of bortezomib-based induction treatment consisting of bortezomib, thalidomide and dexamethasone, and achieved a complete remission. After autologous stem cell collection, he received high-dose melphalan followed by autologous haematopoetic stem cell transplantation (HSCT) maintaining the complete remission. He received conditioning regimen with fludarabine and cyclophosphamide, and underwent an outpatient 8/8 matched sibling allogeneic HSCT (Day 0). Acute graft versus host disease (GvHD) prophylaxis consisted of mycophenolate mofetil and tacrolimus. As part of an experimental institutional protocol aimed at decreasing both relapse and chronic GVHD after tandem transplant (Clinicaltrial.gov NCT02308280), on day+120, consolidation therapy was started with bortezomib 1.3 mg/m2 every 2 weeks for a scheduled 26 doses. Five days after the start of consolidation therapy (day+125), he was hospitalised due to diarrhoea. Examinations ruled out enteric pathogens including adenovirus, rotavirus, calicivirus, Clostridium difficile and other pathogenic bacteria as well as parasites. Further examinations led to the identification of pathologic grade I acute GVHD, and the clinical presentation was therefore compatible with acute GVHD grade III with isolated intestinal involvement. Hence, bortezomib was temporarily discontinued, and he received treatment with methylprednisolone, oral prednisone, tacrolimus, beclometasone [beclomethasone] and mycophenolate mofetil. He was discharged after 18 days of hospitalisation. He was again hospitalised on day+204 due to suprapubic pain, chills, haematuria and resurgence of diarrhoea. At the time of this admission, he was on prednisone 15 mg/day and bortezomib. Examinations showed enterococcal pyelonephritis, haemorrhagic cystitis with presence of adenovirus in the urine culture and relapsed intestinal GvHD. Hence, the man’s bortezomib therapy was discontinued, and his treatment was started with unspecified broad spectrum antibiotics and vigorous hydration. Subsequently, the symptoms of cystitis resolved. After that, the dose of prednisone was increased to 50 mg/day and the dose of tacrolimus was adjusted to maintain a level of 8–12 ng/mL. However, on day +217, his condition deteriorated rapidly and he became confused. Hence, tacrolimus therapy was discontinued despite the level being subtherapeutic. His BP was tightly controlled. A non-enhanced head CT scan showed diffuse hypodensities involving bilateral parietooccipital regions without any mass effect or haemorrh