Successful treatment of orthopneumovirus infection in a patient with primary diffuse B-cell large cell lymphoma of the central nervous system
D. S. Tikhomirov,
D. A. Koroleva,
О. О. Shchetsova,
Е. N. Ignatova,
I. E. Kostina,
T. A. Tupoleva,
E. E. Zvonkov https://doi.org/10.35754/0234-5730-2026-71-1-99-107
Abstract
Introduction. Oncohematological patients are a vulnerable category in relation to orthopneumovirus (OPV), which affects cells of the respiratory epithelium and lung tissue.
Aim: to present a clinical observation of the identification of OPV and successful ribavirin treatment of a patient with Diffuse large B-cell lymphoma (DLBCL) and acute respiratory failure (ARF) due to viral pneumonia.
Main findings. Patient S., 56 years old, was diagnosed with DLBCL of the central nervous system. After the first course of chemotherapy, he developed acute kidney injury, fever, and bilateral pneumonia with ARF. DNA of Pneumocystis jirovecii was found in bronchoalveolar lavage (BAL) fluid. Therapy with co-trimoxazole and micafungin had no effect. Repeated examination of the BAL fluid did not reveal the DNA of Pneumocystis jirovecii. An extended virological examination revealed OPV RNA in a nasal smear, and ribavirin was added to the therapy. During the following days, normalization of body temperature was noted for the first time, after 3 days there was a regression of ARF. Thus, ribavirin has been shown to be highly effective in cases of confirmed OPV infection.
About the Authors
D. S. Tikhomirov
National Medical Research Center for Hematology
Russian Federation
Russian Federation
Dmitry S. Tikhomirov, Cand. Sci. (Biol.), Head of the Laboratory of Virology
125167, Moscow
D. A. Koroleva
National Medical Research Center for Hematology
Russian Federation
Russian Federation
Daria A. Koroleva, Cand. Sci. (Med.), Hematologist, Department of Hematology and Chemotherapy of Lymphomas with Bone Marrow and Hematopoietic Stem Cell Transplantation Unit
125167, Moscow
О. О. Shchetsova
National Medical Research Center for Hematology
Russian Federation
Russian Federation
Olga O. Shchetsova, hematologist, Department of Hematology and Chemotherapy of Lymphomas with Bone Marrow and Hematopoietic Stem Cell Transplantation Unit
125167, Moscow
Е. N. Ignatova
National Medical Research Center for Hematology
Russian Federation
Russian Federation
Elena N. Ignatova, leading specialist of the laboratory for the analysis of posttransfusion viral infections
125167, Moscow
I. E. Kostina
National Medical Research Center for Hematology
Russian Federation
Russian Federation
Irina E. Kostina, Cand. Sci. (Med.), Head of Radiology Department
125167, Moscow
T. A. Tupoleva
National Medical Research Center for Hematology
Russian Federation
Russian Federation
Tatiana A. Tupoleva, Dr. Sci. (Med.), Head of the Virology Department, Head of the Department of Blood Transfusion Infectious Safety
125167, Moscow
E. E. Zvonkov
National Medical Research Center for Hematology
Russian Federation
Russian Federation
Evgeny E. Zvonkov, Dr. Sci. (Med.), Head of the Department of Hematology and Chemotherapy of Lymphomas with Bone Marrow and Hematopoietic Stem Cell Transplantation Unit
125167, Moscow
References
1. Krivitskaya V.Z. Respiratory syncytial virus infection. Pathogenesis peculiarities, prevention and treatment strategies. Voprosy sovremennoi pediatrii. 2013;12(2):35–43 (In Russian).
2. Snopkova M.S., Romanova O.N., Kolomiets N.D. Respiratory-syncytial viral infection. Pathogenesis features, prevention and treatment strategy. Klinicheskaya infektologiya i parazitologiya. 2024;13(2):225–41 (In Russian). DOI: 10.34883/PI.2024.13.2.047.
3. Khanna N., Widmer A.F., Decker M., et al. Respiratory syncytial virus infection in patients with hematological diseases: single-center study and review of the literature. Clin Infect Dis. 2008;46(3):402–12. DOI: 10.1086/525263.
4. Munawar I., Park M., Birnbaum J., Gradon, J. Respiratory syncytial virus in a pancytopenic patient with lower respiratory tract infection: treat fi rst, investigate later. Chest. 2020;158(4):A453. DOI: 10.1016/j.chest.2020.08.437.
5. Ljungman P., Ward K.N., Crooks B.N., et al. Respiratory virus infections after stem cell transplantation: a prospective study from the Infectious Diseases Working Party of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2001;28(5):479–84. DOI: 10.1038/sj.bmt.1703139.
6. Mikulska M., Del Bono V, Gandolfo N, et al. Epidemiology of viral respiratory tract infections in an outpatient haematology facility. Ann Hematol. 2014;93(4):669–76. DOI: 10.1007/s00277-013-1912-0.
7. Khawaja F., Chemaly R.F. Respiratory syncytial virus in hematopoietic cell transplant recipients and patients with hematologic malignancies. Haematologica. 2019;104(7):1322. DOI: 10.3324/haematol.2018.215152.
8. Eisenhut M. Extrapulmonary manifestations of severe respiratory syncytial virus infection — a systematic review. Crit. Care. 2006;10(4):107. DOI: 10.1186/cc4984.
9. Farina F., Sannipoli D., Diral E., et al. Impact of Respiratory Syncytial Virus (RSV) on adult haematology oncology patients. J Infect. 2024;89(6):106347. DOI: 10.1016/j.jinf.2024.106347.
10. Vakil E., Sheshadri A., Faiz S.A., et al. Risk factors for mortality after respiratory syncytial virus lower respiratory tract infection in adults with hematologic malignancies. Transplant Infect Dis. 2018;20(6):e12994. DOI: 10.1111/tid.12994.
11. Mackman R.L., Chien J., Siegel D.S. Presatovir: A Once‐daily Oral Respiratory Syncytial Virus Fusion Inhibitor for the Treatment of Respiratory Syncytial Virus Infection in Adults and Infants. Trend Antiv Drug Develop. 2025;2:309–32. DOI: 10.1002/9783527845088.ch09.
12. Koroleva D.A., Zvonkov E.E., Shchetsova O.O., et al. Biopsy-free diagnosis of primary diffuse large B-cell lymphoma of the central nervous system. Gematologiya i transfuziologiya. 2024;69(3):368–83 (In Russian). DOI: 10.35754/0234-5730-2024-69-3-368-383.
13. Program treatment of diseases of the blood system: a collection of diagnostic algorithms and protocols for the treatment of diseases of the blood system. Parovichnikova E.N., ed. Moscow: Praktika; 2024 (In Russian).
14. Tejada S., Martinez-Reviejo R., Karakoc H.N., et al. Ribavirin for treatment of subjects with respiratory syncytial virus-related infection: a systematic review and meta-analysis. Adv Ther. 2022;39(9):4037–51. DOI: 10.1007/s12325-022-02256-5.
15. ClinicalTrials. gov. A Study of Rilematovir (JNJ‐53718678) in Adult Outpatients With Respiratory Syncytial Virus (RSV) Infection (PRIMROSE). 2023.
16. Riccò M., Corrado S., Palmieri S., Marchesi F. Respiratory Syncytial Virus: A Systematic Review and Meta-Analysis of Tomographic Findings (2000–2022). Children. 2023;10:1169. DOI: 10.3390/children10071169.
17. Mayer J.L., Lehners N., Egerer G., et al. CT-Morphological Characterization of Respiratory Syncytial Virus (RSV) Pneumonia in Immune-Compromised Adults. Fortschr Röntgenstr. 2014;186:686–92. DOI: 10.1055/s-0033-1356353.
18. Gabutti G., De Motoli F., Sandri F., et al. Viral respiratory infections in hematological patients. Infectious diseases and therapy. 2020;9(3):495–510. DOI: 10.1007/s40121-020-00313-6.
19. Garanzha T.A., Tikhomirov D.S., Tupoleva T.A., et. al. The laboratory diagnostic of herpes viral infections under nosocomial pneumonia in oncologic hematologic patients. Klinicheskaya laboratornaya diagnostika. 2015;60(3):50–4 (In Russian).
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For citations:
Tikhomirov D.S., Koroleva D.A., Shchetsova О.О., Ignatova Е.N., Kostina I.E., Tupoleva T.A., Zvonkov E.E. Successful treatment of orthopneumovirus infection in a patient with primary diffuse B-cell large cell lymphoma of the central nervous system. Russian journal of hematology and transfusiology. 2026;71(1):99-107. (In Russ.) https://doi.org/10.35754/0234-5730-2026-71-1-99-107
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