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Hemolytic anemia, thrombocytopenia, and disseminated intravascular coagulation have all been reported. Oral hairy leukoplakia is an uncommon benign lesion most frequently associated with human immunodeficiency virus (HIV) infection. Although reported in the setting of HSCT, it is exceptionally rare [90]. The development of post-transplant lymphoproliferative disorder (PTLD) is the most often encountered and most feared complication of EBV infection after HSCT. Risk is greatest among those who are EBV-seronegative prior to transplant.

1. Clinical Syndromes Primary infection with HHV-8 among immunocompetent children has been associated with a mononucleosis-like syndrome, while in adults, it is a milder illness and frequently asymptomatic. In immunocompromised patients, primary infection has been associated with a wide array of clinical presentations, including mononucleosis in patients with non-Hodgkin’s lymphoma after autologous HSCT [110], bone marrow suppression after renal transplantation or autologous HSCT [111], hemophagocytic syndrome in a patient after renal transplantation and others with HIV infection [112, 113], and in one report of an infant with DiGeorge syndrome, disseminated disease with hepatitis, enterocolitis, and pneumonitis [114].

The latter two are generally reserved for infections caused by ganciclovir-resistant strains of CMV because they can cause significant nephrotoxicity and other side effects. Other agents are less well-studied; use of ancillary agents may have benefit in certain clinical scenarios (Table 2-8). Both valganciclovir and ganciclovir are capable of inducing hematologic abnormalities including neutropenia, anemia, and thrombocytopenia. 7-fold greater bioavailability than oral ganciclovir. A 900 mg dose of valganciclovir is able to achieve a systemic exposure of IV ganciclovir dosed at 5 mg/kg [57], and has now replaced oral ganciclovir in clinical practice [54].

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