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Published in: BMC Infectious Diseases 1/2014

Open Access 01-12-2014 | Case report

Norovirus-related chronic diarrhea in a patient treated with alemtuzumab for chronic lymphocytic leukemia

Authors: Anne-Marie Ronchetti, Benoit Henry, Katia Ambert-Balay, Pierre Pothier, Justine Decroocq, Véronique Leblond, Damien Roos-Weil

Published in: BMC Infectious Diseases | Issue 1/2014

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Abstract

Background

Norovirus infection is increasingly recognized as an important cause of persistent gastroenteritis in immunocompromised hosts and can be a potential cause of morbidity in these populations.

Case presentation

Here, we report a case of norovirus-related chronic diarrhea occurring in a 62-year-old immunocompromised patient treated with alemtuzumab for chronic lymphocytic leukemia. Despite different therapeutic strategies including tapering of immunosuppressive therapy and immunoglobulin administration, diarrhea unfortunately did not resolve and lasted for a total of more than twelve weeks with prolonged norovirus fecal excretion.

Conclusions

Norovirus infection can occur in the setting of alemtuzumab treatment, even as a single agent, and should be included in the differential diagnoses of acute and chronic diarrhea in these immunocompromised patients. Although the administration of oral immunoglobulin has been described as a promising efficient therapy, this was not the case in our patient. Clinical trials are thus clearly warranted to better define risk factors and efficient therapies for norovirus infection in immunocompromised populations.
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Literature
1.
go back to reference Glass RI, Parashar UD, Estes MK: Norovirus gastroenteritis. N Engl J Med. 2009, 361 (18): 1776-1785. 10.1056/NEJMra0804575.CrossRefPubMed Glass RI, Parashar UD, Estes MK: Norovirus gastroenteritis. N Engl J Med. 2009, 361 (18): 1776-1785. 10.1056/NEJMra0804575.CrossRefPubMed
2.
go back to reference Bok K, Green KY: Norovirus gastroenteritis in immunocompromised patients. N Engl J Med. 2012, 367 (22): 2126-2132. 10.1056/NEJMra1207742.CrossRefPubMed Bok K, Green KY: Norovirus gastroenteritis in immunocompromised patients. N Engl J Med. 2012, 367 (22): 2126-2132. 10.1056/NEJMra1207742.CrossRefPubMed
3.
go back to reference Roos-Weil D, Ambert-Balay K, Lanternier F, Mamzer-Bruneel MF, Nochy D, Pothier P, Avettand-Fenoel V, Anglicheau D, Snanoudj R, Bererhi L, Thervet E, Lecuit M, Legendre C, Lortholary O, Zuber J: Impact of norovirus/sapovirus-related diarrhea in renal transplant recipients hospitalized for diarrhea. Transplantation. 2011, 92 (1): 61-69. 10.1097/TP.0b013e31821c9392.CrossRefPubMed Roos-Weil D, Ambert-Balay K, Lanternier F, Mamzer-Bruneel MF, Nochy D, Pothier P, Avettand-Fenoel V, Anglicheau D, Snanoudj R, Bererhi L, Thervet E, Lecuit M, Legendre C, Lortholary O, Zuber J: Impact of norovirus/sapovirus-related diarrhea in renal transplant recipients hospitalized for diarrhea. Transplantation. 2011, 92 (1): 61-69. 10.1097/TP.0b013e31821c9392.CrossRefPubMed
4.
go back to reference Roddie C, Paul JP, Benjamin R, Gallimore CI, Xerry J, Gray JJ, Peggs KS, Morris EC, Thomson KJ, Ward KN: Allogeneic hematopoietic stem cell transplantation and norovirus gastroenteritis: a previously unrecognized cause of morbidity. Clin Infect Dis. 2009, 49 (7): 1061-1068. 10.1086/605557.CrossRefPubMed Roddie C, Paul JP, Benjamin R, Gallimore CI, Xerry J, Gray JJ, Peggs KS, Morris EC, Thomson KJ, Ward KN: Allogeneic hematopoietic stem cell transplantation and norovirus gastroenteritis: a previously unrecognized cause of morbidity. Clin Infect Dis. 2009, 49 (7): 1061-1068. 10.1086/605557.CrossRefPubMed
5.
go back to reference Frange P, Touzot F, Debre M, Heritier S, Leruez-Ville M, Cros G, Rouzioux C, Blanche S, Fischer A, Avettand-Fenoel V: Prevalence and clinical impact of norovirus fecal shedding in children with inherited immune deficiencies. J Infect Dis. 2012, 206 (8): 1269-1274. 10.1093/infdis/jis498.CrossRefPubMed Frange P, Touzot F, Debre M, Heritier S, Leruez-Ville M, Cros G, Rouzioux C, Blanche S, Fischer A, Avettand-Fenoel V: Prevalence and clinical impact of norovirus fecal shedding in children with inherited immune deficiencies. J Infect Dis. 2012, 206 (8): 1269-1274. 10.1093/infdis/jis498.CrossRefPubMed
6.
go back to reference Wingfield T, Gallimore CI, Xerry J, Gray JJ, Klapper P, Guiver M, Blanchard TJ: Chronic norovirus infection in an HIV-positive patient with persistent diarrhoea: a novel cause. J Clin Virol. 2010, 49 (3): 219-222. 10.1016/j.jcv.2010.07.025.CrossRefPubMed Wingfield T, Gallimore CI, Xerry J, Gray JJ, Klapper P, Guiver M, Blanchard TJ: Chronic norovirus infection in an HIV-positive patient with persistent diarrhoea: a novel cause. J Clin Virol. 2010, 49 (3): 219-222. 10.1016/j.jcv.2010.07.025.CrossRefPubMed
7.
go back to reference Saif MA, Bonney DK, Bigger B, Forsythe L, Williams N, Page J, Babiker ZO, Guiver M, Turner AJ, Hughes S, Wynn RF: Chronic norovirus infection in pediatric hematopoietic stem cell transplant recipients: a cause of prolonged intestinal failure requiring intensive nutritional support. Pediatr Transplant. 2011, 15 (5): 505-509. 10.1111/j.1399-3046.2011.01500.x.CrossRefPubMed Saif MA, Bonney DK, Bigger B, Forsythe L, Williams N, Page J, Babiker ZO, Guiver M, Turner AJ, Hughes S, Wynn RF: Chronic norovirus infection in pediatric hematopoietic stem cell transplant recipients: a cause of prolonged intestinal failure requiring intensive nutritional support. Pediatr Transplant. 2011, 15 (5): 505-509. 10.1111/j.1399-3046.2011.01500.x.CrossRefPubMed
8.
go back to reference Elter T, Vehreschild JJ, Gribben J, Cornely OA, Engert A, Hallek M: Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab. Ann Hematol. 2009, 88 (2): 121-132. 10.1007/s00277-008-0566-9.CrossRefPubMed Elter T, Vehreschild JJ, Gribben J, Cornely OA, Engert A, Hallek M: Management of infections in patients with chronic lymphocytic leukemia treated with alemtuzumab. Ann Hematol. 2009, 88 (2): 121-132. 10.1007/s00277-008-0566-9.CrossRefPubMed
9.
go back to reference Robles JD, Cheuk DK, Ha SY, Chiang AK, Chan GC: Norovirus infection in pediatric hematopoietic stem cell transplantation recipients: incidence, risk factors, and outcome. Biol Blood Marrow Transplant. 2012, 18 (12): 1883-1889. 10.1016/j.bbmt.2012.07.005.CrossRefPubMed Robles JD, Cheuk DK, Ha SY, Chiang AK, Chan GC: Norovirus infection in pediatric hematopoietic stem cell transplantation recipients: incidence, risk factors, and outcome. Biol Blood Marrow Transplant. 2012, 18 (12): 1883-1889. 10.1016/j.bbmt.2012.07.005.CrossRefPubMed
10.
go back to reference Sdiri-Loulizi K, Ambert-Balay K, Gharbi-Khelifi H, Sakly N, Hassine M, Chouchane S, Guediche MN, Pothier P, Aouni M: Molecular epidemiology of norovirus gastroenteritis investigated using samples collected from children in Tunisia during a four-year period: detection of the norovirus variant GGII.4 Hunter as early as January 2003. J Clin Microbiol. 2009, 47 (2): 421-429. 10.1128/JCM.01852-08.CrossRefPubMed Sdiri-Loulizi K, Ambert-Balay K, Gharbi-Khelifi H, Sakly N, Hassine M, Chouchane S, Guediche MN, Pothier P, Aouni M: Molecular epidemiology of norovirus gastroenteritis investigated using samples collected from children in Tunisia during a four-year period: detection of the norovirus variant GGII.4 Hunter as early as January 2003. J Clin Microbiol. 2009, 47 (2): 421-429. 10.1128/JCM.01852-08.CrossRefPubMed
11.
go back to reference Chagla Z, Quirt J, Woodward K, Neary J, Rutherford C: Chronic norovirus infection in a transplant patient successfully treated with enterally administered immune globulin. J Clin Virol. 2013, 58 (1): 306-308. 10.1016/j.jcv.2013.06.009.CrossRefPubMed Chagla Z, Quirt J, Woodward K, Neary J, Rutherford C: Chronic norovirus infection in a transplant patient successfully treated with enterally administered immune globulin. J Clin Virol. 2013, 58 (1): 306-308. 10.1016/j.jcv.2013.06.009.CrossRefPubMed
12.
go back to reference Ludwig A, Adams O, Laws HJ, Schroten H, Tenenbaum T: Quantitative detection of norovirus excretion in pediatric patients with cancer and prolonged gastroenteritis and shedding of norovirus. J Med Virol. 2008, 80 (8): 1461-1467. 10.1002/jmv.21217.CrossRefPubMed Ludwig A, Adams O, Laws HJ, Schroten H, Tenenbaum T: Quantitative detection of norovirus excretion in pediatric patients with cancer and prolonged gastroenteritis and shedding of norovirus. J Med Virol. 2008, 80 (8): 1461-1467. 10.1002/jmv.21217.CrossRefPubMed
13.
go back to reference Florescu DF, Hermsen ED, Kwon JY, Gumeel D, Grant WJ, Mercer DF, Kalil AC: Is there a role for oral human immunoglobulin in the treatment for norovirus enteritis in immunocompromised patients?. Pediatr Transplant. 2011, 15 (7): 718-721. 10.1111/j.1399-3046.2011.01556.x.CrossRefPubMed Florescu DF, Hermsen ED, Kwon JY, Gumeel D, Grant WJ, Mercer DF, Kalil AC: Is there a role for oral human immunoglobulin in the treatment for norovirus enteritis in immunocompromised patients?. Pediatr Transplant. 2011, 15 (7): 718-721. 10.1111/j.1399-3046.2011.01556.x.CrossRefPubMed
14.
go back to reference Florescu DF, Hill LA, McCartan MA, Grant W: Two cases of Norwalk virus enteritis following small bowel transplantation treated with oral human serum immunoglobulin. Pediatr Transplant. 2008, 12 (3): 372-375. 10.1111/j.1399-3046.2007.00875.x.CrossRefPubMed Florescu DF, Hill LA, McCartan MA, Grant W: Two cases of Norwalk virus enteritis following small bowel transplantation treated with oral human serum immunoglobulin. Pediatr Transplant. 2008, 12 (3): 372-375. 10.1111/j.1399-3046.2007.00875.x.CrossRefPubMed
15.
go back to reference Martin SI, Marty FM, Fiumara K, Treon SP, Gribben JG, Baden LR: Infectious complications associated with alemtuzumab use for lymphoproliferative disorders. Clin Infect Dis. 2006, 43 (1): 16-24. 10.1086/504811.CrossRefPubMed Martin SI, Marty FM, Fiumara K, Treon SP, Gribben JG, Baden LR: Infectious complications associated with alemtuzumab use for lymphoproliferative disorders. Clin Infect Dis. 2006, 43 (1): 16-24. 10.1086/504811.CrossRefPubMed
16.
go back to reference Capizzi T, Makari-Judson G, Steingart R, Mertens WC: Chronic diarrhea associated with persistent norovirus excretion in patients with chronic lymphocytic leukemia: report of two cases. BMC Infect Dis. 2011, 11: 131-10.1186/1471-2334-11-131.CrossRefPubMedPubMedCentral Capizzi T, Makari-Judson G, Steingart R, Mertens WC: Chronic diarrhea associated with persistent norovirus excretion in patients with chronic lymphocytic leukemia: report of two cases. BMC Infect Dis. 2011, 11: 131-10.1186/1471-2334-11-131.CrossRefPubMedPubMedCentral
17.
go back to reference Ebdrup L, Bottiger B, Molgaard H, Laursen AL: Devastating diarrhoea in a heart-transplanted patient. J Clin Virol. 2011, 50 (4): 263-265. 10.1016/j.jcv.2010.11.007.CrossRefPubMed Ebdrup L, Bottiger B, Molgaard H, Laursen AL: Devastating diarrhoea in a heart-transplanted patient. J Clin Virol. 2011, 50 (4): 263-265. 10.1016/j.jcv.2010.11.007.CrossRefPubMed
18.
go back to reference Lyman WH, Walsh JF, Kotch JB, Weber DJ, Gunn E, Vinje J: Prospective study of etiologic agents of acute gastroenteritis outbreaks in child care centers. J Pediatr. 2009, 154 (2): 253-257. 10.1016/j.jpeds.2008.07.057.CrossRefPubMed Lyman WH, Walsh JF, Kotch JB, Weber DJ, Gunn E, Vinje J: Prospective study of etiologic agents of acute gastroenteritis outbreaks in child care centers. J Pediatr. 2009, 154 (2): 253-257. 10.1016/j.jpeds.2008.07.057.CrossRefPubMed
Metadata
Title
Norovirus-related chronic diarrhea in a patient treated with alemtuzumab for chronic lymphocytic leukemia
Authors
Anne-Marie Ronchetti
Benoit Henry
Katia Ambert-Balay
Pierre Pothier
Justine Decroocq
Véronique Leblond
Damien Roos-Weil
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Infectious Diseases / Issue 1/2014
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/1471-2334-14-239

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