CMV Enteritis and Guillain-Barré Syndrome after Stem Cell Transplantation for Lymphoma
Keywords:
Lymphoma, Stem cell transplantation, Guillain-Barré syndromeAbstract
We report a 31-year-old male from Kuwait, diagnosis of advanced diffuse large B-cell lymphoma stage IV presented with extradural mass and spinal cord compression at T6 level. After T7-T8 laminectomy with 4 cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) chemotherapy and high dose methotrexate (MTX) only one time then followed with 4 cycles of rituximab, cyclophosphamide, vincristine, doxorubicin, and dexamethasone (R-Hyper CVAD)/high dose MTX and cytarabine (Ara-C). The non-myeloablative stem cell transplantation (NMSCT) was performed because of morbid obesity (body weight 135 kg). The conditioning regimen was thiotepa, fludarabine and cyclophosphamide. The graft versus host disease (GVHD) prophylaxis was short-course methotrexate and tacrolimus. The patient developed chronic diarrhea with abdominal pain caused by CMV colitis on day 57 post-transplant and was treated with ganciclovir. Subsequently he developed Guillain-Barré syndrome manifested with progressive weakness of lower extremity which successful treatment with intravenous immunoglobulin (IVIg) 2 g/kg. The recovery of motor power was starting 2 days later. By the same period, patient developed pancytopenia from stem cell rejection. The 0.95 x 106/kg of stem cell was re-infused on day 72 post-transplant and reachieved engraftment 13 days later. The motor power was recovered from grade I to grade IV and he was able to walk with walker support after 25 days treatment of IVIg
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