Oral ribavirin therapy for lower respiratory tract infection of respiratory syncytial virus complicating bronchiolitis obliterans after allogeneic hematopoietic stem cell transplantation

Excerpt

Respiratory syncytial virus (RSV) is the leading cause of community-acquired viral respiratory infection, particularly in pediatric patients [1]. RSV usually causes self-limited upper respiratory tract infection in healthy individuals. However, in contrast, RSV often causes serious lower respiratory tract infection (LRTI) in recipients of hematopoietic stem cell transplantation (HSCT), and outbreaks of RSV infection in hematology or HSCT wards have also been reported [2‐5]. RSV infection has been increasingly diagnosed and is currently detected in about half of the HSCT recipients with community-acquired respiratory virus infection [6]. Because of its propensity to cause life-threatening infections [1], anti-viral therapy is indicated in HSCT recipients who develop RSV infection, particularly LRTI. Aerosolized ribavirin is the only approved therapeutic agent against RSV infection at present. However, its clinical benefit is limited, and it is associated with adverse events in patients and potential toxic effects in health care workers [7]. Therefore, the safety and efficacy of systemic administration of high-dose ribavirin have been evaluated by several investigators, but the results remain inconclusive. We here present a patient with bronchiolitis obliterans (BO) who developed respiratory failure caused by LRTI due to RSV more than 2 years after allogeneic HSCT. The patient was successfully treated with oral ribavirin at a dose of 600 mg/body/day, and a prompt eradication of RSV as well as resolution of LRTI was obtained. …