Fatal disseminated adenoviral infection associated with thrombotic thrombocytopenic purpura after allogeneic bone marrow transplantation

Adenoviruses are increasingly recognized as a significant cause of morbidit y and mortality in immunocompromised patients. We report on a patient who, approximately 4 weeks after allogeneic stem cell transplantation, developed fever, new liver lesions and thrombotic microangiopathy. Adenovirus type 2 was isolated from blood and urine samples. Liver biopsy showed parenchymal necrosis with intranuclear viral inclusion bodies. Immunohistochemistry wa s positive for adenovirus. In addition, on electron microscopy the morpholo gic pattern was highly suggestive of adenovirus. The patient died on post-t ransplant day 40. The relatively early post-transplant presentation of diss eminated adenoviral disease and its possible association with a TTP-like pi cture are rather unusual after allogeneic transplantation.