Document Detail

Asymmetric peripheral neuropathy following reduced-intensity cord blood transplantation
MedLine Citation:
PMID:  19110521     Owner:  NLM     Status:  MEDLINE    
A 57-year-old male patient in the first remission of acute erythroid leukemia underwent reduced-intensity umbilical cord blood transplantation. He developed grade III acute graft-versus-host disease (GVHD) on day 29. Although the acute GVHD was resolved with tacrolimus and steroid therapy, weakness developed in the left upper extremity on day 59. Neurological examination demonstrated asymmetric muscular weakness of the extremities with the proximal part of the left upper extremity being markedly affected. Neurophysiological studies suggested that this was due to immune-mediated demyelinating neuropathy. Intravenous immunoglobulin (IVIG) therapy was administered at a dose of 0.4 g/kg/day for 5 days and worsening of clinical symptoms ceased. While the patient developed diarrhea and chronic GVHD of the skin and cytomegalovirus (CMV) antigenemia was repeatedly positive, neurological exacerbation was stabilized. Neurological symptoms did not immediately improve after the second and third dose of IVIG. Approximately 50 days after the third dose of IVIG, neurological symptoms improved with the gradual resolution of diarrhea and CMV reactivation. Although the pathophysiology of polyneuropathies after allo-SCT is not well understood, some reports suggest an association with GVHD or alloreactive T cell expansion following antecedent infection. This case provides valuable information regarding the pathophysiology of peripheral neuropathy following allo-SCT.
Masahiko Sumi; Naoaki Ichikawa; Shunichi Sato; Ikuo Shimizu; Mihoko Yotsumoto; Mayumi Ueno; Hikaru Kobayashi
Publication Detail:
Type:  Case Reports; English Abstract; Journal Article    
Journal Detail:
Title:  [Rinshō ketsueki] The Japanese journal of clinical hematology     Volume:  49     ISSN:  0485-1439     ISO Abbreviation:  Rinsho Ketsueki     Publication Date:  2008 Dec 
Date Detail:
Created Date:  2008-12-26     Completed Date:  2009-06-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  2984782R     Medline TA:  Rinsho Ketsueki     Country:  Japan    
Other Details:
Languages:  jpn     Pagination:  1604-8     Citation Subset:  IM    
Department of Hematology, Nagano Red Cross Hospital, Japan.
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MeSH Terms
Acute Disease
Cord Blood Stem Cell Transplantation / adverse effects*
Graft vs Host Disease / drug therapy,  etiology
Immunoglobulins, Intravenous / administration & dosage
Leukemia, Erythroblastic, Acute / therapy
Middle Aged
Peripheral Nervous System Diseases / etiology*,  therapy
Tacrolimus / therapeutic use
Transplantation Conditioning / adverse effects*
Reg. No./Substance:
0/Immunoglobulins, Intravenous; 109581-93-3/Tacrolimus

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