Human bocavirus (HBoV) is frequently detected in young children with respiratory symptoms. However, the prevalence and pathogenicity of HBoV in immunocompromised patients are largely unknown. This report describes a case of life-threatening hypovolemic shock due to diarrhea associated with disseminated HBoV infection in an immunocompromised child.
CASE REPORTA 9-year-old boy with erythropoietic protoporphyria was admitted to the University Medical Center Groningen, Groningen, The Netherlands. He had undergone orthotopic liver transplantation and allogeneic hematopoietic stem cell transplantation 9 and 4 months prior to admission, respectively. He presented with fever, nausea, vomiting, and diarrhea of 1-day duration. Clinical examination showed a moderately sick boy with a temperature of 39.5°C, tachycardia (pulse rate, 150 beats per min), normal blood pressure, and normal hydration status. Pulmonary examination detected a minor cough and minor rales upon auscultation. Examination of the abdomen revealed hyperperistalsis, no tenderness, and palpable edges of the liver and spleen. Laboratory results showed an elevated C-reactive protein level (51 mg liter Ϫ1 ; normal, Յ10 mg liter Ϫ1 ) and erythrocyte sedimentation rate (106 mm h Ϫ1 ; normal, Յ25 mm h Ϫ1 ) and a normal leukocyte count. The patient had severe therapy-induced lymphopenia (20 CD3 ϩ T cells l Ϫ1 ; normal range, 700 to 4,200 l Ϫ1 ). Liver chemistry test results were stable but elevated due to biliary complications after liver transplantation. Bacterial blood cultures and fecal cultures for Campylobacter, Salmonella, and Shigella spp. and Escherichia coli O157 were negative. PCR analyses of feces for noroviruses (genogroups I and II), adenovirus, parechovirus, enterovirus, and cytomegalovirus and antigen detection assays of feces for rotavirus and astrovirus were all negative. In contrast, feces results were positive for human bocavirus (HBoV) by PCR (threshold cycle [C T ] value in week 49 of 2007, 17) (Fig.