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Open Access Case report

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

Anne-Marie Ronchetti1, Benoit Henry2, Katia Ambert-Balay3, Pierre Pothier3, Justine Decroocq1, Véronique Leblond1 and Damien Roos-Weil1*

Author Affiliations

1 Hematology Department, Hôpital Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie Paris 06, GRC 11 (GRECHY), Paris, France

2 Tropical and Infectious Diseases Department, Hôpital Pitié-Salpétrière, AP-HP, Université Pierre et Marie Curie, Paris, France

3 Centre National de Référence des Virus Entériques, CHU de Dijon, Dijon, France

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BMC Infectious Diseases 2014, 14:239  doi:10.1186/1471-2334-14-239

Published: 6 May 2014

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.

Keywords:
Norovirus; Diarrhea; Immunosuppression; Alemtuzumab; Chronic lymphocytic leukemia