Summary:Bacterial meningoencephalitis occurring in the pre-engraftment period after bone marrow transplantation (BMT) is a rare complication, and the feasibility of granulocyte transfusion (GTX) in such cases remains to be elucidated. A 37-year-old man developed enterococcal meningoencephalitis during a severely granulocytopenic pre-engraftment period after BMT. Despite therapy with appropriate antibiotics, cultures of blood and cerebrospinal fluid (CSF) continued to grow Enterococcus faecalis, and he developed rapid mental deterioration and seizure. Granulocytes were collected from his HLAmismatched, ABO-matched sibling with subcutaneous injection of granulocyte colony-stimulating factor (G-CSF) and oral dexamethazone. Transfusion of 4.4 Â 10 10 granulocytes resulted in a 12-h post-transfusion granulocyte increment of 2.0 Â 10 9 /l, and maintained peripheral blood granulocyte counts above 0.5 Â 10 9 /l for 3 days. A rapid increase of granulocytes in CSF was also observed, and cultures of blood and CSF became negative after GTX. A transient worsening of seizure was observed as a potential side effect of GTX. The patient subsequently developed septic shock because of Pseudomonas aeruginosa and died. Further studies are warranted to evaluate the clinical efficacy of GTX for the treatment of uncontrolled infections in granulocytopenic stem cell transplant recipients. Bone Marrow Transplantation (2003) 31, 69-72. doi:10.1038/sj.bmt.1703780 Keywords: enterococcus; meningoencephalitis; granulocyte transfusion; G-CSF; bone marrow transplantation Bacterial or fungal infections continue to be a major cause of morbidity and mortality during the post-transplant period until engraftment. Recently, the incidence of vancomycin-resistant Enterococcus (VRE)-related infection has been increasing, and its treatment has become a serious problem during the pre-engraftment period following BMT. 1-3 However, Enterococci rarely cause CNS infection in granulocytopenic patients, and there are few anecdotal cases of meningoencephalitis due to Enterococcus faecalis after BMT. [4][5][6] Transfusion of normal granulocytes is a logical treatment for severe bacterial infections in neutropenic patients. However, granulocyte transfusion (GTX) had a limited role in the treatment of such infections before the wide clinical use of granulocytes colony stimulating factor (G-CSF). A major reason for the lack of efficacy was that the dose of granulocytes collected and transfused was inadequate. The availability of G-CSF prompted several investigators to re-evaluate the efficacy of GTX in the treatment of uncontrolled bacterial and fungal infection during granulocytopenia. Bielorai et al reported a case of VRE septicemia in a neutropenic patient, which was successfully treated with GTX. 3 The phase I/II trials of GTX mobilized by G-CSF for the treatment of infections complicated with hematological disorders also demonstrated its efficacy. 7 These trials also demonstrated the migratory activity of transfused granulocytes to the tissue site; however, whe...
