Successful treatment of parainfluenza virus 3 pneumonia with oral ribavirin and methylprednisolone in a bone marrow transplant recipient
Successful treatment of parainfluenza virus 3 pneumonia with oral ribavirin and methylprednisolone in a bone marrow transplant recipient
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DOI：
10.1007/s12185-008-0148-6
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发表时间：
2008-10-01
影响因子：
2.1
通讯作者：
Nagafuji, Koji
中科院分区：
文献类型：
--
作者：
Shima, Takahiro;Yoshimoto, Goichi;Nagafuji, Koji
我们报告一例严重的副流感病毒（PIV）3型肺炎的造血干细胞移植受体，成功地治疗口服利巴韦林和甲基强的松龙。一名42岁的妇女诊断为急性髓性白血病（FAB M5 a）在第一次完全缓解接受异基因骨髓移植从HLA匹配无关的捐助者在2006年5月。2007年7月，她患上了PPV 3肺炎。她的呼吸状态进行性恶化，需要以6 L/min吸入O-2。在获得知情同意后，于7月31日开始口服利巴韦林（16 mg/kg/天）1周。到治疗第3天，高热消失。但在停用利巴韦林后复发。此外，患者缺氧持续加重，需要以9 L/min吸入O-2。为了抑制PIV 3肺炎引起的肺部炎症反应，8月11日开始静脉注射甲泼尼龙（1，000 mg，每日1次，共3天），同时沿着大剂量口服利巴韦林（16 mg/kg，每日）。患者临床症状明显改善，于9月3日停止吸氧。我们的病例表明，伴随有效的抗病毒治疗，皮质类固醇可以抑制导致呼吸衰竭的宿主炎症或免疫反应。
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 O-2 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 O-2 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.