Abstract Details

Title A Case Report of Acute CNS Graft Versus Host Disease (GvHD) with Concurrent Infections

Topic Autoimmune Neurology

Presentation(s) P3 - Poster Session 3 (12:00 PM-1:00 PM)

Poster/Presentation
Number 085

Objective To ponder upon optimal treatment strategies for overlapping acute CNS GvHD and infections(candidemia, toxoplasmosis and CMV viremia) in post Hematopoietic Stem Cell Transplant(HPSCT) patients

Background GvHD is one of the most severe complications of HPSCT and the mainstay of treatment is immunosuppressive therapy. However, there are no definitive guidelines about treatment when there is concurrent infection. Some possible biomarkers are described in literature for CNS GvHD but they need to be tested for validity of results. Here we report a case that presented with confusion, initial findings concerning for acute GvHD of skin, liver and GIT involvement, MRI findings of abnormal hyper-intensities with contrast enhancement in bilateral globus pallidus, bilateral periventricular region and bilateral para-midline cerebellum, CSF findings of lymphocytic meningitis in the absence of infectious organisms with elevated IGg index, biopsy proven CNS GvHD that showed mild myelin pallor along with T-lymphocytic and histiocytic infiltrates, in the absence of findings to suggest neoplastic, lymphoid, metastatic or demyelinating process. Patient was found to have concurrent vitreous toxoplasmosis (PCR proven) and worsening serum beta glucan despite being tried on clindamycin, bactrim, meropenem, daptomycin, tigecycline and ambisome. With worsening mentation and MRI brain lesions, patient was tried of high dose steroids, IVIG as well as plasmapharesis with minimal improvement. Pt developed DIC and had to be taken off of plasmapharesis. She was then started on Alemtuzumab for steroid resistant GvHD but died of septic shock 4 months after the HPSCT.

Design/Methods case report

Results N/A

Conclusions Due to paucity of guidelines available for treatment strategies for CNS GvHD, it is one of the most fatal complications of HPSCT. In the presence of ongoing infections, the treatment modalities are even less effective and often result in suboptimal treatment.

Authors/Disclosures
Hira Zafar, MBBS (Uams) PRESENTER	Dr. Zafar has nothing to disclose.
Shubham Biyani, MBBS	Dr. Biyani has nothing to disclose.
Rohan Sharma, MD	Dr. Sharma has nothing to disclose.
Nidhi Kapoor, MD, MBBS, FAAN	Dr. Kapoor has nothing to disclose.

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