Case Report Severe respiratory syncytial virus pneumonia complicating fludarabine and cyclophosphamide treatment of chronic lymphocytic leukemia Respiratory syncytial virus (RSV) is a well recog- nised pathogen, most commonly associated with childhood respiratory illnesses such as bronchioli- tis and pneumonitis (1). In healthy adult hosts most RSV infections are minor and self-limited. However, among severely immunocompromised patients, such as those having undergone allogeneic bone marrow transplantation or chemotherapy for acute leukaemia, RSV can cause life-threatening pneumonia (2, 3). Less severely immunosuppressed patients are not usually considered to be at risk for severe illness due to RSV. We recently encoun- tered a patient with chronic lymphocytic leukae- mia (CLL) with severe RSV pneumonia, and this case expands the spectrum of patients who should be considered at risk for serious morbidity and potential mortality from this common viral pathogen. Case report A 62-yr-old man, with a 6-yr history of CLL (CD5+, CD19+, CD20+, CD23+, CD38–), was admitted during the winter of 2001 with a fever of 38.8°C, a cough productive of yellow sputum, mild headache and sore throat, sweating, and rigors. He presented on day 27 following the first cycle of fludarabine (25 mg m )2 IV daily · 3) and cyclo- phosphamide (250 mg m )2 IV daily · 3) (4). His past history included treated peptic ulcer disease and moderate alcohol intake of 2–3 standard drinks daily. The patient was a lifelong non-smoker. Prior therapy for his CLL had been with inter- mittent low-dose chlorambucil and prednisolone. His disease had become refractory to this treat- ment, and he had bulky splenomegaly and abdo- minal adenopathy, Rai stage II, with an Eastern Co-operative Oncology Group (ECOG) perfor- mance status of 1. Prior to commencing fludarabine and cyclophos- phamide, his white cell count was 77 · 10 9 L )1 (lymphocytes 73, neutrophils 3.8), with normal haemoglobin, platelets, lactate dehydrogenase (LDH) and b 2 -microglobulin. Serum gammaglobu- lin levels were moderately reduced at 4gL )1 (reference range 8–16 g L )1 ) without any serum paraprotein present. Review at day 17 of the first cycle of therapy had shown a decreased lymphocyte count to 6.9 · 10 9 L )1 , and he was neutropenic (0.42 · 10 9 L )1 ) but well. Field K, Slavin MA, Seymour JF. Severe respiratory syncytial virus pneumonia complicating fludarabine and cyclophosphamide treatment of chronic lymphocytic leukemia. Eur J Haematol 2002: 69: 54–57. Ó Blackwell Munksgaard 2002. Abstract: The potential for life-threatening pneumonia due to respira- tory syncytial virus (RSV) infection is recognised among patients with acute leukaemia and recipients of allogeneic or autologous bone marrow transplantation. RSV pneumonia has a high mortality rate in these settings. Less intensively treated patients are not usually considered to be at risk for serious RSV pneumonia. We describe the case of a 62-yr-old patient with chronic lymphocytic leukaemia (CLL) treated with fludarabine and cyclophosphamide who developed severe RSV pneumonia and recovered following treatment including intravenous ribavirin. K. Field 1 , M.A. Slavin 2 , J.F. Seymour 1 Departments of 1 Haematology and 2 Infectious Diseases, Peter MacCallum Cancer Institute, Australia Key words: respiratory syncytial virus; RSV; chronic lymphocytic leukaemia; fludarabine; cyclophosphamide Correspondence: Dr John F. Seymour, Department of Haematology, Peter MacCallum Cancer Institute, St. Andrew's Place, East Melbourne, VIC 3002, Australia Tel: + 613 96561700 Fax: + 613 96561408 e-mail: jseymour@petermac.unimelb.edu.au Accepted for publication 19 June 2002 Eur J Haematol 2002: 69: 54–57 Printed in UK. All rights reserved Copyright Ó Blackwell Munksgaard 2002 EUROPEAN JOURNAL OF HAEMATOLOGY ISSN 0902-4441 54