CYTOMEGALOVIRUS-ASSOCIATED STAGE-4S NEUROBLASTOMA RELAPSED STAGE-4

Neuroblastoma is one of the most frequent solid tumors in childhood, r arely recurrent after five years from diagnosis. Cytomegalovirus (CMV) , a major pathogen causing congenital birth defects and severe opportu nistic diseases, has been shown to have teratogenic, immunodepressive and oncogenic properties. The case of a girl with stage 4S neuroblasto ma diagnosed at three months and relapsed as stage 4 five years later is reported. In both circumstances, active CMV infection was revealed by positive CMV-specific IgM and IgA antibodies, CMV-DNAemia and CMV c ulture. At three months, the patient presented with subcutaneous nodul es, hepatosplenomegaly and increased aminotransferase levels, and the opsoclonus-myoclonus syndrome. Mental retardation developed later on. At 5 years, relapsed neuroblastoma was preceded by a mononucleosis-lik e syndrome concomitant with active CMV infection and decreased levels of immune cells and natural killer activity. Clinical, virologic, and immunologic findings suggest an immune-mediated pathogenic role for CM V in this tumor. (C) 1995 Wiley-Liss, Inc.