Central nervous system (CNS) tuberculosis following allogeneic stem cell transplantation

Abstract

Summary:Tuberculosis is an uncommon infectious complication after stem cell transplantation. We report a patient who presented with a brain mass, 3 months after pulmonary tuberculosis had been diagnosed and while he was receiving triple antituberculous therapy. He had extensive chronic GVHD. The diagnosis was made after biopsy of the lesion. The cerebral mass was excised, antituberculous treatment was maintained and the patient made a complete neurologic recovery. Six months later, he died of gram-negative septic shock. Mycobacterial infections should be considered in allograft recipients with chronic GVHD and solid lesions in the brain. Bone Marrow Transplantation (2000) 25, 567-569. Keywords: stem cell transplantation; graft-versus-host disease; tuberculosis Tuberculosis remains a major problem in the world today. It is estimated that one third of the world population is infected with Mycobacterium tuberculosis, with more than eight million new cases and nearly three million deaths occurring each year.1 Tuberculosis is directly responsible for 7% of all deaths world-wide, and the global pandemic is likely to worsen as a result of the spread of drug-resistant organisms and the ongoing human immune-deficiency virus (HIV) epidemic.2 Stem cell transplant recipients have severely impaired cell-mediated immunity as a result of their underlying disease, pre-transplant chemotherapy and radiation, graft-versus-host disease (GVHD) and its treatment. Considering mycobacteria epidemiology characteristics and the severe immune-suppression after stem cell transplantation, a high incidence of mycobacterial infections would be expected. However, this infection is uncommon, even in endemic areas, and the literature is relatively sparse concerning this subject. 3,4

Tuberculosis in stem cell transplant patients

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22] The data show that the ratio of TB in allogeneic SCT patients correlates with the country's TB rate, as mentioned above (Table IV). Detailed analysis of the same data shows that there is no increased risk of TB in autologous SCT patients, which suggests that there is no need to take extra measures against TB in these patients.…”

Infections Caused by Mycobacterium tuberculosis in Recipients of Hematopoietic Stem Cell Transplantation

“…Extra-pulmonary sites of infection include: liver, spleen, bone, bone marrow, brain, and spine (1, 13, 16, 24, 32, 38, 39). Central nervous system involvement may take the form of space occupying lesions in the brain.…”

Central Nervous System Complications and Outcomes After Allogeneic Hematopoietic Stem Cell Transplantation

“…Allo-HSCT patients are at a heightened risk of central nervous system complications (CNSC) in addition to several other organ toxicities. 4,5 The potential risk factors for CNSC include the toxicities of total body irradiation (TBI) used in conditioning regimen 6,7 as well as the use of immunosuppressants such as cyclosporine 8 and tacrolimus, 9 immunocompromised status leading to increased susceptibility to central nervous system infections, [10][11][12][13] and GVHD. 7,14 Furthermore, CNSC can contribute to the increased mortality and thus compromise long-term outcome of allo-HSCT.…”