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Guillain–Barre syndrome associated with rapid immune reconstitution following allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 37, pages 617–619 (2006)Cite this article

Guillain–Barre syndrome (GBS) is a rare complication following hematopoietic stem cell transplantation (HSCT), and its pathogenesis remains unclear. GBS in the early post transplant period has been attributed to the conditioning regimen, particularly cytosine arabinoside.1 In contrast, the etiology of GBS in the late post transplant period remains unknown.2 Some reports suggest an association with antecedent infections such as cytomegalovirus (CMV) and Campylobacter pylori. As few cases of GBS during acute graft-versus-host disease (acute GVHD) have been reported, acute GVHD is unlikely to be the cause of GBS.2 We report a patient who developed GBS during rapid immune reconstitution following allogeneic HSCT.

A 34-year-old woman with acute lymphoblastic leukemia in the second remission underwent allogeneic peripheral blood stem cell transplantation from a one-antigen-mismatched related donor. The conditioning regimen comprised of cyclophosphamide and busulfan. GVHD prophylaxis was cyclosporine and short-term methotrexate. Diffuse erythema and diarrhea appeared on day 20; acute GVHD was diagnosed after skin biopsy. We initiated methylprednisolone 1 mg/kg, to which GVHD gradually responded. On day 30, she developed abdominal pain and was positive for CMV pp65 antigenemia. CMV colitis was diagnosed after colonoscopy with tissue biopsy. Her symptoms gradually improved with ganciclovir, and CMV antigenemia turned negative on day 70. On day 78, she complained of muscle weakness in the lower extremities, which progressed to quadriplegia on day 85. Muscle weakness was prominent in the proximal lower extremities. Deep tendon reflexes were absent in all the four extremities. Autonomic nervous and sensory function remained clinically normal. Magnetic resonance images of the whole spinal cord failed to show any abnormalities. Cerebrospinal fluid (CSF) showed normal levels of cell counts, protein, and glucose. CSF cultures and polymerase chain reaction using CMV-specific primers were negative. Serological tests for myasthenia gravis and anti-ganglioside antibody were also negative. Nerve conduction studies showed no conduction blocks, while the amplitudes of action potentials of compound muscle and sensory nerve were abnormally reduced. Electromyelography showed fibrillation potentials and positive sharp waves, which were consistent with denervation of muscle fibers. A sural nerve biopsy revealed axonal degeneration with infiltration of CD8+ T cells and macrophages. Based on these findings, axonal type GBS was diagnosed.

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References

  1. Rodriguez V, Kuehnle I, Heslop HE, Khan S, Krance RA . Guillain–Barre syndrome after allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 2002; 29: 515–517.

    Article  CAS  Google Scholar 

  2. Wen PY, Alyea EP, Simon D, Herbst RS, Soiffer RJ, Antin JH . Guillain–Barre syndrome following allogeneic bone marrow transplantation. Neurology 1997; 49: 1711–1714.

    Article  CAS  Google Scholar 

  3. Brew BJ . The peripheral nerve complications of human immunodeficiency virus (HIV) infection. Muscle Nerve 2003; 28: 542–552.

    Article  CAS  Google Scholar 

  4. Yuki N . Infectious origins of, and molecular mimicry in, Guillain–Barre and Fisher syndromes. Lancet Infect Dis 2001; 1: 29–37.

    Article  CAS  Google Scholar 

  5. Visser LH, van der Meche FG, Meulstee J, Rothbarth PP, Jacobs BC, Schmitz PI et al. Cytomegalovirus infection and Guillain–Barre syndrome: the clinical, electrophysiologic, and prognostic features. Dutch Guillain–Barre Study Group. Neurology 1996; 47: 668–673.

    Article  CAS  Google Scholar 

  6. Jacobs BC, van Doorn PA, Groeneveld JH, Tio-Gillen AP, van der Meche FG . Cytomegalovirus infections and anti-GM2 antibodies in Guillain–Barre syndrome. J Neurol Neurosurg Psychiatry 1997; 62: 641–643.

    Article  CAS  Google Scholar 

  7. Kojima K, Kurokawa MS, Tanimoto K, Kojima Y, Hara M, Yoshino T et al. Clonal expansion of limited T cell clonotypes in affected muscle from a patient with post-transplant polymyositis. Bone Marrow Transplant 2002; 30: 467–470.

    Article  CAS  Google Scholar 

  8. King C, Ilic A, Koelsch K, Sarvetnick N . Homeostatic expansion of T cells during immune insufficiency generates autoimmunity. Cell 2004; 117: 265–277.

    Article  CAS  Google Scholar 

  9. Peggs KS, Mackinnon S . Immune reconstitution following haematopoietic stem cell transplantation. Br J Haematol 2004; 124: 407–420.

    Article  Google Scholar 

  10. Sherer Y, Shoenfeld Y . Autoimmune diseases and autoimmunity post-bone marrow transplantation. Bone Marrow Transplant 1998; 22: 873–881.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Hematopoietic Stem Cell Transplantation Unit, The National Cancer Center Hospital, Tokyo, Japan

    G Fujisaki, M Kami, N Murashige, Y Kishi, A Hori, A Chizuka & R Tanosaki

  2. Department of Neurology, Division of Neuroscience, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

    Y Ugawa

  3. Department of Hematology, The JR Tokyo General Hospital, Tokyo, Japan

    K Kobayashi

  4. Division of Exploratory Research, The Institute of Medical Science, University of Tokyo, Tokyo, Japan

    M Kami, A Hori & K Kobayashi

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  1. G Fujisaki
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  2. M Kami
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Correspondence to M Kami.

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Fujisaki, G., Kami, M., Murashige, N. et al. Guillain–Barre syndrome associated with rapid immune reconstitution following allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 37, 617–619 (2006). https://doi.org/10.1038/sj.bmt.1705283

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