INFECTIOUS COMPLICATIONS OF AUTOLOGOUS HEMATOPOIETIC STEM CELL TRANSPLANTATION FOR PATIENTS WITH SYSTEMIC SCLEROSIS: A CLINICAL CASE AND LITERATURE REVIEW

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Laboratorinė medicina. 2020,
t. 22,
Nr. 1,
p. 19 -
25

Summary

Background. Systemic sclerosis is a rare autoimmune connective tissue disease that affects the skin and many internal organs and is associated with impaired qual ity of life and the risk of premature death. Autologous hematopoietic stem cell transplantation in hibits disease progression and significantly improves the clinical condition of the patients, but can lead to many serious complications.

Case presentation. A 46-year-old woman who developed joint swelling of both hands af ter an acute upper respiratory in fec tion was treated with methyl - prednisolone and methotrexate. Gradually dry mouth, Raynaud’s phenomenon, shortness of breath, pain and swelling of many joints, and skin thickening appeared. The pa tient was di ag nosed with sys temic sclerosis and methotrexate and nifedipine were pre scribed. Due to insufficient response to treatment and rapid disease progression, autologous hemato - poietic stem cell transplantation was performed. Shortness of breath, joint pain and swelling, and skin condition improved. Half a year later, an acute upper respiratory infection recurred, af ter which the patient’s condition began to deteriorate. Reactivation of Ep stein–Barr virus was detected and treated with rituximab. Shortness of breath progressed, the patient developed precapillary pulmonary hypertension and heart failure, episodes of fever and urinary tract infections re curred frequently. About a year after the transplantation, the patient died.

Conclusions. Infections are common complications after autologous hematopoietic stem cell transplantation. The most commonly identified infectious agents are herpes simplex, varicella- zoster, cytomegalovirus, and Epstein–Barr viruses, which latently persist in the body after the primary infection. Immune reconstitution after transplantation takes about a year, so pharmacological prophylaxis and revaccination are needed.

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