Viral infections in acute graft-versus-host disease: A review of diagnostic and therapeutic approaches

• Published in: Journal of the American Academy of Dermatology Vol. 72; no. 4; pp. 696 - 702
• Main Authors: Tong, Lana X., BA, Worswick, Scott D., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2015
• Subjects: Acute Disease; Adenoviridae Infections - diagnosis; Adenoviridae Infections - drug therapy; Adenoviridae Infections - etiology; cytomegalovirus; Dermatology; Disease Susceptibility; Epstein–Barr virus; Graft vs Host Disease - complications; Graft vs Host Disease - drug therapy; graft-versus-host disease; Hepatitis, Viral, Human - diagnosis; Hepatitis, Viral, Human - drug therapy; Hepatitis, Viral, Human - etiology; Herpesviridae Infections - diagnosis; Herpesviridae Infections - drug therapy; Herpesviridae Infections - etiology; Host-Pathogen Interactions; human herpesvirus 6; human herpesvirus 7; Humans; Immunocompromised Host; Immunosuppressive Agents - adverse effects; Immunosuppressive Agents - therapeutic use; inpatient dermatology; Parvoviridae Infections - diagnosis; Parvoviridae Infections - drug therapy; Parvoviridae Infections - etiology; Parvovirus B19, Human; Respiratory Tract Infections - complications; Respiratory Tract Infections - virology; transplant dermatology; viral infections; Virus Activation; Virus Diseases - diagnosis; Virus Diseases - drug therapy; Virus Diseases - etiology; acute graft-versus-host disease; HHV6; hepatitis B virus; varicella virus; inpatient dermatology; lymphadenopathy; viral infections; leukocytoclastic vasculitis; VZV; cytomegalovirus; EBV; hepatitis C virus; HBV; Epstein–Barr virus; human herpesvirus 6; CMV; LAD; human herpesvirus 7; transplant dermatology; aGVHD; RSV; HCV; respiratory syncytial virus; graft-versus-host disease; LCV
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2014.12.002

Background While immunosuppressive therapy for acute graft-versus-host disease (aGVHD) advances, viral reactivation has been found to be an increasingly common complication in these patients. Dermatologists may often be consulted on inpatient services for evaluation. Objective We investigated the literature for the role of viral infections in aGVHD and review the current evidence regarding management. Methods Articles in the public domain regarding aGVHD, cytomegalovirus, Epstein–Barr virus, varicella zoster virus, hepatitis viruses, parvovirus B19, and respiratory viruses were included. Results Dermatologic findings vary between different viral antigens, and some infections may be a marker for the development of aGVHD or worsen prognosis. Limitations The heterogeneous cohorts of the studies reviewed often preclude direct comparison between results. Conclusion The relationship between viral reactivation and aGVHD may be bidirectional and is worthy of further exploration. Additional studies are needed to determine appropriate prophylaxis and treatment.