Figure 4: Immunological features of a patient with primary CMV-infection and subsequent development of CMV-colitis. A. Viral load (copies/ml), straight line, black; Percentage of activated CD8⁺ T cells (HLAdr⁺/CD38⁺), dashed line, black; Percentage of perforin-expression by CD8⁺ T cells, dashed line, dark grey; Percentage effector cells (CD45RO^-/CD27^-) of CD8⁺ T cells. Percentages of proliferating (B) and IFNγ-producing (C) CD4⁺ and CD8⁺ T cells in response to pp65 or IE1. Viral load (copies/ml), straight line, black; Percentage responding CD4⁺ (straight line) and CD8⁺ (dashed line) T cells in response to pp65 (light grey) and IE1 (dark grey). S.C. CMV-seroconversion, striped box: treatment with ganciclovir. D. FACS staining on several time points post-SCT of the production of IFNγ and IL-2 by CD8+ T cells after stimulation with pp65 or IE1. Percentages of IFNγ⁺CD8⁺ T cells are indicated.
This patient was transplanted with stem cells from a matched, related, CMV-seropositive donor after non-myeloablative conditioning. After SCT, CMV load became detectable on day 45 and the patient subsequently developed CMV-colitis after 58 days, as diagnosed by histology of sigmoid biopsies. The patient had not developed GVHD at time of diagnosis of CMV-colitis. CMV load reached a maximum viral load of 1.7^*10⁴ copies/ml on day 64. The patient was treated with intravenous ganciclovir from day 56 till day 92. From day 90 onwards CMV load remained undetectable for at least one year. Serology was performed to confirm primary CMV-infection. IgM and IgG became detectable three months after the first detection of CMV load (day 136 post SCT).