Successful unrelated mismatched cord blood transplantation in an infant with severe combined immunodeficiency and Mycobacterium bovis bacillus Calmette‐Guèrin disease

Abstract

The case reported here of an infant who presented with Pneumocystis carinii pneumonia, CD4+ lymphopenia, and hypogammaglobulinemia attributable to severe combined immunodeficiency (SCID). This report discussed treatment of Mycobacterium bovis bacillus Calmette-Guèrin disease with unrelated cord blood transplantation in addition to antituberculous therapy, by adoptively transferring donor immunity with induction of mixed chimerism. Because of the unique nature of umbilical cord blood hematopoietic cells, engraftment without conditioning may be possible in SCID patients without fully matched donors.

Successful treatment of BCG‐related immune reconstitution inflammatory syndrome following ex vivo T‐cell–depleted haploidentical hematopoietic stem cell transplantation: A case report

“…Three of them had no prior evidence of infection, yet developed either local or disseminated infection following HSCT as in our case . Sixteen of them had infection prior to HSCT, and dissemination process had occurred before transplantation as a result of inadequate immunity …”

“…Abu Arja et al reviewed 19 reported cases of BCG infection that had been reported in post‐transplant patients with PID . Three of them had no prior evidence of infection, yet developed either local or disseminated infection following HSCT as in our case .…”

“…[6][7][8] Sixteen of them had infection prior to HSCT, and dissemination process had occurred before transplantation as a result of inadequate immunity. [8][9][10][11]14,15 BCG lymphadenitis occurred at post-transplant day 110 in our patient, and this reaction was closely associated with T-cell reconstitution on day 92. The timing of the HSCT and development of lymphadenitis in our case fits into the interval determined by previously reported cases (within 1-18 months following HSCT, in most cases within 4 months).…”

“…4,5 Abu Arja et al reviewed 19 reported cases of BCG infection that had been reported in post-transplant patients with PID. [6][7][8][9][10][11][12][13][14][15] Three of them had no prior evidence of infection, yet developed either local or disseminated infection following HSCT as in our case. [6][7][8] Sixteen of them had infection prior to HSCT, and dissemination process had occurred before transplantation as a result of inadequate immunity.…”

“…Since suppurative lymphadenitis usually progresses and forms a sinus tract, which takes months to heal, a safer option would be to prevent sinus tract formation by aspirating the fluid inside the mass and aspiration process can be repeated if needed. Surgical excision, however, is not recommended due to poor wound healing and the risk of fistulization . Surgical excision option is usually saved for cases which already have sinus formation, for multiloculated mass (as in our case), and for when needle aspiration fails.…”