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VDRL screening and haemopoietic stem cell transplantation

Bone Marrow Transplantation volume 35, pages 1027–1028 (2005)Cite this article

Haematopoietic stem cell transplantation (HSCT) is a form of transfusion, and donors are screened for diseases transmissible by transfusion. Syphilis exposure is screened by either Venereal Disease Research Laboratory (VDRL) test or Treponema pallidum Haemagglutination Assay, and confirmed by Fluorescent Treponema Antibody (FTA-Abs) test. Positive donors are traced and referred. HSCT recipients are also screened for baseline documentation and to avoid exacerbation of latent syphilis during stem cell transplantation (SCT). Between 1989 and 2004, 845 consecutive adult HSCT were performed in Queen Mary Hospital (male to female 1.28 to 1, median age 36 years, range 16–67), including 178 autologous and 667 allogeneic HSCT. The donors (male to female 1.23 to 1, median age 35 years, range 9–58) were either siblings (n=554), unrelated donors (n=103) and parental or children donors (n=10). Commercial kits were used for the detection of VDRL reactivity (Becton Dickinson, Maryland, USA) and FTA-Abs (Trepo-Spot IF, bioMerieux, Marcy I' Etoile, France). Spirochaete detection in biopsy specimens was performed by silver staining and dark field microscopy. One case each of VDRL-positive recipient (0.12%) and donor (0.15%) were detected.

Case 1: A 42-year-old Nepalese man underwent allogeneic HSCT for chronic myeloid leukaemia in accelerated phase. Screening for VDRL (1:32) and confirmation by FTA-Abs were positive and he volunteered regular venereal exposure. He was treated with intramuscular benzthine penicillin G 2.4 MU weekly for 3 weeks with undetectable VDRL titre, while the marrow was cryopreserved from sibling donor coming over from Nepal. However, VDRL titres increased again (1:32) during conditioning 3 months later. The patient volunteered interval venereal exposure and he was re-treated with one dose of benzthine penicillin 2.4 MU and 2 weeks of ceftriaxone 1 g daily (day −7 to 7) when VDRL titre became undetectable. He engrafted on day 17 with grade IV GVHD of skin and liver (bilirubin: 560 μmol/l, normal 7–19; SGOT/GPT: 197/474 U/l, normal 12–28/5–31). A liver biopsy showed GVHD with negative viral and spirochaete detection. He continued to suffer from cholestasis, haemorrhagic cystitis and severe GVHD, despite treatment with steroids and azathioprine. Repeat testing for FTA-Abs and VDRL post-HSCT remained negative. At 6 months follow-up, he presented with a fungating penile mass, fever and hepatitis after venereal exposure. Skin and liver biopsy showed disseminated Trichosporon beigelii fungal infection without evidence of syphilis or other venereal infections. He died despite intensive anti-fungal treatment.

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Authors and Affiliations

  1. Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China

    W Y Au & A K W Lie

  2. Department of Microbiology, Queen Mary Hospital, Hong Kong SAR, China

    V C C Cheng

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Au, W., Lie, A. & Cheng, V. VDRL screening and haemopoietic stem cell transplantation. Bone Marrow Transplant 35, 1027–1028 (2005). https://doi.org/10.1038/sj.bmt.1704941

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