An immunological syndrome featuring transverse myelitis, Evans syndrome and pulmonary infiltrates after unrelated bone marrow transplant in a patient with severe aplastic anemia

• Published in: Bone marrow transplantation (Basingstoke) Vol. 26; no. 11; pp. 1225 - 1228
• Main Authors: RICHARD, S, FRUCHTMAN, S, SCIGLIANO, E, SKERRETT, D, NAJFELD, V, ISOLA, L
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01.12.2000
• Subjects: Adult; Anemia; Anemia, Aplastic - therapy; Anemia, Hemolytic, Autoimmune - etiology; Anemia, Hemolytic, Autoimmune - immunology; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Aplastic anemia; Biological and medical sciences; Bone marrow; Bone marrow transplantation; Bone Marrow Transplantation - adverse effects; Bone Marrow Transplantation - immunology; Bone marrow, stem cells transplantation. Graft versus host reaction; Cramps; Dermatitis; Eosinophilia; Graft vs Host Disease - etiology; Graft vs Host Disease - immunology; Graft-versus-host reaction; Hemolytic anemia; Humans; Idiopathic thrombocytopenic purpura; Immunology; Immunosuppression; Inflammatory diseases; Lung - pathology; Lung diseases; Male; Medical sciences; Muscles; Myelitis; Myelitis - etiology; Myelitis - immunology; Pulmonary Eosinophilia - etiology; Pulmonary Eosinophilia - immunology; Purpura, Thrombocytopenic, Idiopathic - etiology; Purpura, Thrombocytopenic, Idiopathic - immunology; Spinal cord; Stem cell transplantation; Syndrome; Transfusions. Complications. Transfusion reactions. Cell and gene therapy; Transplantation; Lung; Homograft; Autoimmune disease; Male; Hemopathy; Evans syndrome; Inflammatory disease; Transverse myelitis; Infiltrate; Bone marrow; Adult; Complication; Graft; Human; Immunopathology; Lung disease; Nervous system diseases; Respiratory disease; Unrelated donor; Aplastic anemia; Graft versus host reaction; Case study; Platelet; Treatment; Central nervous system disease; Spinal cord disease
• ISSN: 0268-3369; 1476-5365
• DOI: 10.1038/sj.bmt.1702677

A patient with severe aplastic anemia underwent a matched unrelated bone marrow transplant, following which he developed a complex autoimmune syndrome. This featured transverse myelitis, immune mediated Coombs positive hemolytic anemia and immune thrombocytopenia (Evans syndrome), pulmonary infiltrates, eosinophilia, muscle pains and cramps and lichenoid dermatitis all of which may represent manifestations of graft-versus-host disease as they showed response to immunosuppression. Thus, although immune-mediated cytopenias after an allogeneic bone marrow transplant are rare, they should be considered as a possible cause of cytopenia in post-transplant patients.