Diagnostic and therapeutic challenges

摘要

A 35-year-old Vietnamese physician presented to the clinic in December 2010 with reduced vision in both the eyes for 4 months. His medical history is significant for a myelodysplastic syndrome, refractory anemia with excess blasts-2, which transformed into acute myeloid leukemia, for which he received 3 cycles of azacitidine and 1 cycle of FLAG chemotherapy (fludarabine, cytarabine, and granulocyte colony-stimulating factor regimen) before eventually undergoing a reduced intensity-matched unrelated donor stem cell transplant in June 2010. Before his transplant, the patient was found to be positive for cytomegalovirus (CMV) and herpes simplex virus in the serum; the donor was also positive for CMV. After transplantation, he remained on cyclosporine (75/50 mg 2 times a day) for immunosuppression. His peritransplant course was complicated by Aspergillus pneumonia in April 2010, systemic CMV activation in July 2010 for which he was started on oral valganciclovir, and line-related (Hickman) Klebsiella sepsis in September 2010.