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Granulocyte transfusion as a treatment for enterococcal meningoencephalitis after allogeneic bone marrow transplantation from an unrelated donor

Bone Marrow Transplantation volume 31, pages 69–72 (2003)Cite this article

Summary:

Bacterial meningoencephalitis occurring in the pre-engraftment period after bone marrow transplantation (BMT) is a rare complication, and the feasibility of granulocyte transfusion (GTX) in such cases remains to be elucidated. A 37-year-old man developed enterococcal meningoencephalitis during a severely granulocytopenic pre-engraftment period after BMT. Despite therapy with appropriate antibiotics, cultures of blood and cerebro-spinal fluid (CSF) continued to grow Enterococcus faecalis, and he developed rapid mental deterioration and seizure. Granulocytes were collected from his HLA-mismatched, ABO-matched sibling with subcutaneous injection of granulocyte colony-stimulating factor (G-CSF) and oral dexamethazone. Transfusion of 4.4×1010 granulocytes resulted in a 12-h post-transfusion granulocyte increment of 2.0×109/l, and maintained peripheral blood granulocyte counts above 0.5×109/l for 3 days. A rapid increase of granulocytes in CSF was also observed, and cultures of blood and CSF became negative after GTX. A transient worsening of seizure was observed as a potential side effect of GTX. The patient subsequently developed septic shock because of Pseudomonas aeruginosa and died. Further studies are warranted to evaluate the clinical efficacy of GTX for the treatment of uncontrolled infections in granulocytopenic stem cell transplant recipients.

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Acknowledgements

We thank Mrs Matsuhashi H, MT and the other staff members of the Blood Center of Keio University Hospital for their excellent technical assistance with the PMNC collection. We also thank the staff doctors and nurses at the BMT unit of Keio University Hospital.

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    Y Tsukada, H Nagayama, T Mori, T Shimizu, N Sato, N Takayama, Y Ikeda & S Okamoto

  2. Blood Center, Keio University School of Medicine, Tokyo, Japan

    A Ishida & M Handa

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  1. Y Tsukada
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  2. H Nagayama
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  3. T Mori
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  4. T Shimizu
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  5. N Sato
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  6. N Takayama
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  7. A Ishida
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  8. M Handa
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  10. S Okamoto
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Tsukada, Y., Nagayama, H., Mori, T. et al. Granulocyte transfusion as a treatment for enterococcal meningoencephalitis after allogeneic bone marrow transplantation from an unrelated donor. Bone Marrow Transplant 31, 69–72 (2003). https://doi.org/10.1038/sj.bmt.1703780

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  • DOI: https://doi.org/10.1038/sj.bmt.1703780

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