Advertisement

International Journal of Hematology

, Volume 88, Issue 3, pp 336–340 | Cite as

Successful treatment of parainfluenza virus 3 pneumonia with oral ribavirin and methylprednisolone in a bone marrow transplant recipient

  • Takahiro ShimaEmail author
  • Goichi Yoshimoto
  • Atsushi Nonami
  • Shuro Yoshida
  • Kenjiro Kamezaki
  • Hiromi Iwasaki
  • Katsuto Takenaka
  • Toshihiro Miyamoto
  • Naoki Harada
  • Takanori Teshima
  • Koichi Akashi
  • Koji Nagafuji
Case Report

Abstract

We report a case of severe parainfluenza (PIV) 3 pneumonia in a hematopoietic stem cell transplant recipient that was successfully treated with oral ribavirin and methylprednisolone. A 42-year-old woman diagnosed with acute myelogenous leukemia (FAB M5a) in first complete remission underwent allogeneic bone marrow transplantation from an HLA-matched unrelated donor in May 2006. In July 2007, she developed PIV3 pneumonia. Her respiratory status progressively worsened and she required O2 inhalation at 6 L/min. After an informed consent was obtained, oral ribavirin was initiated (16 mg/kg per day) for 1 week on July 31. By day 3 of treatment, the high-grade fever had disappeared. However, it recurred after ribavirin was discontinued. In addition, the patient’s hypoxia continued to worsen, requiring O2 inhalation at 9 L/min. To suppress the inflammatory reaction in the lung caused by PIV3 pneumonia, intravenous methylprednisolone (1,000 mg once a day for 3 days) was started along with high-dose oral ribavirin (16 mg/kg per day) on August 11. The patient showed dramatic clinical improvement, and oxygen inhalation was discontinued on September 3. Our case suggests that with concomitant effective anti-viral treatment, corticosteroids may suppress host inflammatory or immune reactions that lead to respiratory failure.

Keywords

Ribavirin Parainfluenza virus Pneumonia Bone marrow transplantation 

Notes

Acknowledgments

We thank Dr. Takahiro Fukuda (National Cancer Center Hospital, Tokyo, Japan) for his valuable suggestions.

References

  1. 1.
    Nichols WG, Corey L, Gooley T, Davis C, Boeckh M, et al. Parainfluenza virus infections after hematopoietic stem cell transplantation: risk factors, response to antiviral therapy, and effect on transplant outcome. Blood. 2001;93:573–8. doi: 10.1182/blood.V98.3.573.CrossRefGoogle Scholar
  2. 2.
    Chemaly RF, Ghosh S, Bodey GP, Rohatgi N, Safdar A, Keating MJ, et al. Respiratory viral infections in adults with hematologic malignancies and human stem cell transplantation recipients: a retrospective study at a major cancer center. Medicine. 2006;85:78–287. doi: 10.1097/01.md.0000232560.22098.4e.CrossRefGoogle Scholar
  3. 3.
    Vainionpaa R, Hyypia T. Biology of parainfluenza viruses. Clin Microbiol Rev. 1994;7:265–75.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Laurichesse H, Dedman D, Watson JM, Zambon MC. Epidemiological features of parainfluenza virus infections: laboratory surveillance in England and Wales, 1975–1997. Eur J Epidemiol. 1999;15:475–84. doi: 10.1023/A:1007511018330.CrossRefPubMedGoogle Scholar
  5. 5.
    Chakrabarti S, Avivi I, Mackinnon S, Ward K, Kottaridis PD, Osman H, et al. Respiratory virus infections in transplant recipients after reduced-intensity conditioning with Campath-1H: high incidence but low mortality. Br J Haematol. 2002;119:1125–32. doi: 10.1046/j.1365-2141.2002.03992.x.CrossRefPubMedGoogle Scholar
  6. 6.
    Raboni SM, Nogueira MB, Tsuchiya LR, Takahashi GA, Pereira LA, Pasquini R, et al. Respiratory tract viral infections in bone marrow transplant patients. Transplantation. 2003;76:142–6. doi: 10.1097/01.TP.0000072012.26176.58.CrossRefPubMedGoogle Scholar
  7. 7.
    Elizaga J, Olavarria E, Apperley J, Goldman J, Ward K. Parainfluenza virus 3 infection after stem cell transplant: relevance to outcome of rapid diagnosis and ribavirin treatment. Clin Infect Dis. 2001;32:413–8. doi: 10.1086/318498.CrossRefPubMedGoogle Scholar
  8. 8.
    Sparrelid E, Ljungman P, Ekelof-Andstrom E, Aschan J, Ringden O, Winiarski J, et al. Ribavirin therapy in bone marrow transplant recipients with viral respiratory tract infections. Bone Marrow Transplant. 1997;19:905–8. doi: 10.1038/sj.bmt.1700752.CrossRefPubMedGoogle Scholar
  9. 9.
    Chakrabarti S, Collingham KE, Holder K, Oyaide S, Pillay D, Milligan DW. Parainfluenza virus type 3 infections in hematopoetic stem cell transplant recipients: response to ribavirin therapy. Clin Infect Dis. 2000;31:1516–8. doi: 10.1086/317482.CrossRefPubMedGoogle Scholar
  10. 10.
    Wendt CH, Weisdorf DJ, Jordan MC, Balfour HH Jr, Hertz MI. Parainfluenza virus respiratory infection after bone marrow transplantation. N Engl J Med. 1992;326:921–6.CrossRefPubMedGoogle Scholar
  11. 11.
    Lewis VA, Champlin R, Englund J, Couch R, Goodrich JM, Rolston K, et al. Respiratory disease due to parainfluenza virus in adult bone marrow transplant recipients. Clin Infect Dis. 1996;23:1033–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Lee I, Barton TD. Viral respiratory tract infections in transplant patients: epidemiology, recognition and management. Drugs. 2007;67:1411–27. doi: 10.2165/00003495-200767100-00004.CrossRefPubMedGoogle Scholar
  13. 13.
    Champlin RE, Whimbey E. Community respiratory virus infections in bone marrow transplant recipients: the M. D. Anderson Cancer Center experience. Biol Blood Marrow Transplant. 2001;7:8S–10S. doi: 10.1053/bbmt.2001.v7.pm11777103.CrossRefPubMedGoogle Scholar
  14. 14.
    Crooks BN, Taylor CE, Turner AJ, Osman HK, Abinun M, Flood TJ, et al. Respiratory viral infections in primary immune deficiencies: significance and relevance to clinical outcome in a single BMT unit. Bone Marrow Transplant. 2000;26:1097–102. doi: 10.1038/sj.bmt.1702656.CrossRefPubMedGoogle Scholar
  15. 15.
    Gavin PJ, Katz BZ. Intravenous ribavirin treatment for severe adenovirus disease in immunocompromised children. Pediatrics. 2002;110:e9. doi: 10.1542/peds.110.1.e9.CrossRefPubMedGoogle Scholar
  16. 16.
    Markovic SN, Adlakha A, Smith TF, Walker RC. Respiratory syncytial virus pneumonitis-induced diffuse alveolar damage in an autologous bone marrow transplant recipient. Mayo Clin Proc. 1998;73:153–6.CrossRefPubMedGoogle Scholar
  17. 17.
    Nichols WG, Gooley T, Boeckh M. Community-acquired respiratory syncytial virus and parainfluenza virus infections after hematopoietic stem cell transplantation: the Fred Hutchinson Cancer Research Center experience. Biol Blood Marrow Transplant. 2001;7:11S–5S. doi: 10.1053/bbmt.2001.v7.pm11777098.CrossRefPubMedGoogle Scholar
  18. 18.
    Field K, Slavin MA, Seymour JF. Severe respiratory syncytial virus pneumonia complicating fludarabine and cyclophosphamide treatment of chronic lymphocytic leukemia. Eur J Haematol. 2002;69:54–7. doi: 10.1034/j.1600-0609.2002.02745.x.CrossRefPubMedGoogle Scholar
  19. 19.
    Wright JJ, O’Driscoll G. Treatment of parainfluenza virus 3 pneumonia in a cardiac transplant recipient with intravenous ribavirin and methylprednisolone. J Heart Lung Transplant. 2005;24:343–6. doi: 10.1016/j.healun.2004.01.003.CrossRefPubMedGoogle Scholar
  20. 20.
    Tam VH, Preston SL, Drusano GL. Comparative pharmacokinetic analysis by standard two-stage method versus nonparametric population modeling. Pharmacotherapy. 2003;23:1545–9. doi: 10.1592/phco.23.15.1545.31969.CrossRefPubMedGoogle Scholar
  21. 21.
    Preston SL, Drusano GL, Glue P, Nash J, Gupta SK, McNamara P. Pharmacokinetics and absolute bioavailability of ribavirin in healthy volunteers as determined by stable-isotope methodology. Antimicrob Agents Chemother. 1999;43:2451–6.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Lertora JJ, Rege AB, Lacour JT, Ferencz N, George WJ, VanDyke RB, et al. Pharmacokinetics and long-term tolerance to ribavirin in asymptomatic patients infected with human immunodeficiency virus. Clin Pharmacol Ther. 1991;50:442–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Laskin OL, Longstreth JA, Hart CC, Scavuzzo D, Kalman CM, Connor JD, et al. Ribavirin disposition in high-risk patients for acquired immunodeficiency syndrome. Clin Pharmacol Ther. 1987;41:546–55.CrossRefPubMedGoogle Scholar
  24. 24.
    Croup SN. J Fam Pract. 1993;37:165–70.Google Scholar
  25. 25.
    Luks AM, Neff MJ. Pneumocystis jiroveci pneumonia. Respir Care. 2007;52:59–63.PubMedGoogle Scholar
  26. 26.
    Battikh R, M’Sadek F, Ben Abdelhafidh N, Louzir B, Labidi J, Ajili F, et al. Pneumocystis pneumonia in 3 non HIV patients. Med Mal Infect. 2007;37:605–8. doi: 10.1016/j.medmal.2006.03.005.CrossRefPubMedGoogle Scholar
  27. 27.
    Bozzette SA, Sattler FR, Chiu J, Wu AW, Gluckstein D, Kemper C, et al. A controlled trial of early adjunctive treatment with corticosteroids for Pneumocystis carinii pneumonia in the acquired immunodeficiency syndrome. California Collaborative Treatment Group. N Engl J Med. 1990;323:1451–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Cheng VC, Tang BS, Wu AK, et al. Medical treatment of viral pneumonia including SARS in immunocompetent adult. J Infect. 2004;49:262–73. doi: 10.1016/j.jinf.2004.07.010.CrossRefPubMedGoogle Scholar
  29. 29.
    Adhami N, Arabi Y, Raees A, Al-Shimemeri A, Ur-Rahman M, Memish ZA. Effect of corticosteroids on adult varicella pneumonia: cohort study and literature review. Respirology. 2006;11:437–41. doi: 10.1111/j.1440-1843.2006.00870.x.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2008

Authors and Affiliations

  • Takahiro Shima
    • 1
    Email author
  • Goichi Yoshimoto
    • 2
  • Atsushi Nonami
    • 1
  • Shuro Yoshida
    • 1
  • Kenjiro Kamezaki
    • 1
  • Hiromi Iwasaki
    • 2
  • Katsuto Takenaka
    • 1
  • Toshihiro Miyamoto
    • 2
  • Naoki Harada
    • 1
  • Takanori Teshima
    • 2
  • Koichi Akashi
    • 1
  • Koji Nagafuji
    • 1
  1. 1.Medicine and Biosystemic ScienceKyushu University Graduate School of Medical SciencesFukuokaJapan
  2. 2.Center for Cellular and Molecular MedicineKyushu University Graduate School of Medical SciencesFukuokaJapan

Personalised recommendations