Eosinophilic Esophagitis After Pediatric Hematopoietic Stem Cell Transplantation

Abstract

Food Allergy in Pediatric Recipients of Liver Transplant by Mori et al (1), delineates allergic conditions in children post-liver transplant. While the transfer of allergic diseases and rare eosinophilic gastrointestinal disorders (EGID) after adult hematopoietic stem cell transplant (HSCT) has been reported, at the time of this review, there are no reports of EGID post-pediatric allogeneic HSCT. We share a case of eosinophilic esophagitis (EoE) following pediatric HSCT.A 2-year-old with beta-thalassemia underwent curative matched sibling HSCT. Four months later, he developed abdominal pain, postprandial nausea, and vomiting. Based on symptomatology and 25% eosinophilia in peripheral blood leukocytes, he was empirically diagnosed with upper gastrointestinal graft-versus-host disease (GVHD) and treated with oral prednisone 2 mg/kg/ daily. Symptoms improved but rapidly recrudesced after prednisone discontinuation. Upper endoscopy with biopsies was performed (Fig. 1), with 31, 43, and 35 eosinophils per high power field in the proximal, middle, and distal esophagus, respectively, with no evidence of GVHD.He was diagnosed with EoE and treated with budesonide viscous slurries and pantoprazole, 1 mg/kg/dose twice daily. Based on allergen testing, milk, wheat, eggs, and red food dyes were eliminated from his diet. Symptoms resolved. Repeat endoscopy revealed mucosal healing. Budesonide was discontinued ten months later, with no symptom recurrence, and mucosal healing was maintained.Eosinophilic disorders should be considered in HSCT recipients with gastrointestinal symptoms (2,3). Apparently, new allergies may develop in the HSCT recipient following donor immune reconstitution, often reflecting undiagnosed allergies of the donor (4). Endoscopic biopsies are crucial to diagnosis and definitive management.

Histological Remission of Eosinophilic Esophagitis Following Allogeneic Hematopoietic Stem Cell Transplantation for Acute Myelogenous Leukemia

“…We present the case of a 54-year-old man with EoE who achieved histological remission after undergoing allogeneic HSCT for acute myelogenous leukemia (AML). To our knowledge, successful EoE treatment using allogeneic HSCT has not been reported previously, although the converse has been reported in pediatric populations [ 5 ].…”