Fatal upper and lower gastrointestinal cytomegalovirus disease following autologous peripheral blood stem cell transplantation

Although the life-threatening cytomegalovirus (CMV) disease is a well known complication following allogeneic hematopoietic stem cell transplantation (HSCT), it has been considered infrequent after autologous peripheral blood stem cell transplantation (PBSCT). On the other hand, the massive involvem ent of the gastrointestinal (GI) tract as the primary site of fatal CMV dis ease is particularly rare after autologous PBSCT. We present the case of a woman who suffered from CMV disease after high-dose busulphan/melphalan/thi otepa (BuMelTT) and autologous PBSCT. The primary site of infection was the GI tract, which was extensively affected. During the fifth week post-trans plant the patient started with epigastralgia, diarrhea, fever, GI bleeding, and thrombocytopenia, and she died on day +52. Another case of fatal CMV d isease among the few patients treated with BuMelTT has been recently report ed, which suggests that the immunodeficiency associated with that regimen c an be as intense as that occurring after allogeneic BMT.