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A fatal Clostridium infection in an allogeneic stem cell transplant recipient

Bone Marrow Transplantation volume 36, pages 455–457 (2005)Cite this article

Infection-related mortality after stem cell transplantation is related to patient age, immunological status, duration of neutropenia, comorbid medical conditions and perhaps more importantly, the ability to rapidly identify the pathogen and institute timely appropriate antibiotics. Here, we describe a case that highlights an unusual infection with a very high case-fatality rate, in which early recognition and treatment is critical.

A 73-year-old Caucasian male with multiple myeloma received autologous SCT after BCNU and melphalan. After 5 years, he developed secondary myelodysplastic syndrome/AML associated with an isochromosome 17q. Despite advanced age, with an excellent performance status and no comorbid illnesses, he received an allograft from his HLA-matched sister. Conditioning included busulfan 3.2 mg/kg/day i.v. for 4 days followed by cyclophosphamide at 75 mg/m2/day. A total of 4.08 × 106 G-CSF-mobilized CD34 cells/kg were infused. GVHD prophylaxis was tacrolimus and methotrexate. Antimicrobial prophylaxis included voricanozole, acyclovir and gatifloxacin. On day+5, G-CSF at 5 μg/kg/day was started.

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Acknowledgements

This report is dedicated to the memory of Mr Ken Cook whose words ‘Have Faith, Let Go, Fear Not’ have inspired and sustained many.

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Authors and Affiliations

  1. University of Maryland Greenebaum Cancer Center, Baltimore, MD, USA

    M Jain, A P Rapoport & G Akpek

  2. Infectious Disease, Baltimore, MD, USA

    R Titanji & A Cross

  3. Pathology, Baltimore, MD, USA

    W Wang & C Gocke

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  1. M Jain
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  2. R Titanji
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  7. G Akpek
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Jain, M., Titanji, R., Rapoport, A. et al. A fatal Clostridium infection in an allogeneic stem cell transplant recipient. Bone Marrow Transplant 36, 455–457 (2005). https://doi.org/10.1038/sj.bmt.1705052

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