Bilateral Marginal Keratitis Associated With Engraftment Syndrome After Hematopoietic Stem Cell Transplantation

Abstract

Engraftment syndrome is notable for a rapid recovery of the white blood cell count after hematopoietic stem cell transplantation. Patients who present with presumed conjunctivitis in the setting of autologous and allogeneic stem cell transplantation should be evaluated for engraftment syndrome-related marginal keratitis.

Engraftment Syndrome: An Updated Review

“…ES has been described in several medical conditions including: (10) plasma cell disorders such as multiple myeloma, amyloidosis, POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes) and plasma cell leukemia; (2) leukemias including: acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia (CML) and chronic lymphocytic leukemia; (3) lymphomas, mainly non-Hodgkin types; (4) solid tumors such as breast cancer; and (5) autoimmune disorders such as multiple sclerosis [1,3,10,11,16,22]. In addition to the forms of HSCT and the types of medical illnesses described above, additional risk factors for the development of ES include: (1) female gender, (2) older age, (3) absence of previous chemotherapy or the use of less aggressive chemotherapeutic agents prior to HSCT, (4) use of busulfan, cyclophosphamide, fludarabine and etoposide, (5) The clinical manifestations of ES include: (1) common and characteristic features that include: non-infectious fever; skin rash; PERDS manifested as pulmonary edema, lung infiltrates and hypoxemia; diarrhea; weight gain; renal dysfunction; hepatic dysfunction with jaundice; transient encephalopathy; and capillary leak syndrome manifesting as: weight gain, edema, ascites as well as hypoalbuminemia; and (2) rarely described manifestations which include: severe colitis, pericarditis, acute brachial neuropathy in addition to bilateral marginal keratitis [1][2][3][8][9][10][11]18,24,[27][28][29][30]. The diagnostic criteria for ES are included in Table 1 [1-3,10,11].…”

“Marginal keratitis following COVID 19 vaccination”

“…There have been similar reports of marginal keratitis after nontraditional triggers. In 2007, a patient was reported to have bilateral marginal keratitis after stem cell transplant [7] . In 2014, a patient was found to develop marginal keratitis following Ranibizumab injection [6] .…”

“…In 2014, a patient was found to develop marginal keratitis following Ranibizumab injection [6] . In both scenarios new antigens were introduced to the body and both had negative bacterial and viral cultures of the eye [6] , [7] . These cases support the possibility of a novel vaccine creating a substantial immune response and subsequent type III hypersensitivity reaction to trigger marginal keratitis of the eye.…”