Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation
Parasitic infections by Cryptosporidium species are rare but can be life-threatening disease after allogeneic stem-cell transplantation (allo-SCT). Here, we reported a case of cryptosporidiosis occurring after a reduced-intensity conditioning and allo-SCT in a 64-year-old farmer with diffuse large B...
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| Format: | Article |
| Language: | English |
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Karger Publishers
2023-08-01
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| Series: | Case Reports in Oncology |
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| Online Access: | https://beta.karger.com/Article/FullText/531571 |
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| author | Edwige Boulet Carlos Graux Anne Sonet Julien Depaus Hélène Vellemans Marc André Caroline Fervaille Elodie Collinge |
| author_facet | Edwige Boulet Carlos Graux Anne Sonet Julien Depaus Hélène Vellemans Marc André Caroline Fervaille Elodie Collinge |
| author_sort | Edwige Boulet |
| collection | DOAJ |
| description | Parasitic infections by Cryptosporidium species are rare but can be life-threatening disease after allogeneic stem-cell transplantation (allo-SCT). Here, we reported a case of cryptosporidiosis occurring after a reduced-intensity conditioning and allo-SCT in a 64-year-old farmer with diffuse large B-cell lymphoma. Around day 70 after allo-SCT, he presented with diarrhea attributed to graft-versus-host disease (GvHD) and was treated with immunosuppressive therapy. Due to the patient’s worsening clinical condition, a biopsy review was performed, revealing evidence of cryptosporidiosis. Therefore, immunosuppressive therapy was progressively decreased, and antimicrobial therapy including paromomycin and azithromycin was initiated. Following an increase in diarrhea, a second-line treatment with nitazoxanide was administered, resulting in gradual improvement of symptoms. However, recurrence of cryptosporidiosis occurred despite treatment with paromomycin 6 months after transplant and after an episode of GvHD recurrence and colic cytomegalovirus reactivation. Antiparasitic treatment was stopped and azithromycin and rifaximine were started. Immunosuppressive therapy was also reduced. The good clinical evolution allowed for the cessation of all medications. In conclusion, Cryptosporidium infection can complicate allo-SCT and be mistaken for GvHD at the clinical and histologic levels. Early and accurate diagnosis is all the more important as the therapeutic approach for the two conditions is opposite: reduction versus intensification of immunosuppressive therapy. Nitazoxanide, paromomycin, and azithromycin are the first therapeutic options. |
| first_indexed | 2024-03-12T02:03:57Z |
| format | Article |
| id | doaj.art-1e688c8e64cb49caa615e4e87d9cfe26 |
| institution | Directory Open Access Journal |
| issn | 1662-6575 |
| language | English |
| last_indexed | 2024-03-12T02:03:57Z |
| publishDate | 2023-08-01 |
| publisher | Karger Publishers |
| record_format | Article |
| series | Case Reports in Oncology |
| spelling | doaj.art-1e688c8e64cb49caa615e4e87d9cfe262023-09-07T07:56:38ZengKarger PublishersCase Reports in Oncology1662-65752023-08-0116159159610.1159/000531571531571Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell TransplantationEdwige Boulet0Carlos Graux1Anne Sonet2Julien Depaus3Hélène Vellemans4Marc André5Caroline Fervaille6Elodie Collinge7Hematology Department, CHU UCL Namur, Namur, BelgiumHematology Department, CHU UCL Namur, Namur, BelgiumHematology Department, CHU UCL Namur, Namur, BelgiumHematology Department, CHU UCL Namur, Namur, BelgiumHematology Department, CHU UCL Namur, Namur, BelgiumHematology Department, CHU UCL Namur, Namur, BelgiumAnatomic Pathology Laboratory, CHU UCL Namur, Namur, BelgiumHematology Department, CHU UCL Namur, Namur, BelgiumParasitic infections by Cryptosporidium species are rare but can be life-threatening disease after allogeneic stem-cell transplantation (allo-SCT). Here, we reported a case of cryptosporidiosis occurring after a reduced-intensity conditioning and allo-SCT in a 64-year-old farmer with diffuse large B-cell lymphoma. Around day 70 after allo-SCT, he presented with diarrhea attributed to graft-versus-host disease (GvHD) and was treated with immunosuppressive therapy. Due to the patient’s worsening clinical condition, a biopsy review was performed, revealing evidence of cryptosporidiosis. Therefore, immunosuppressive therapy was progressively decreased, and antimicrobial therapy including paromomycin and azithromycin was initiated. Following an increase in diarrhea, a second-line treatment with nitazoxanide was administered, resulting in gradual improvement of symptoms. However, recurrence of cryptosporidiosis occurred despite treatment with paromomycin 6 months after transplant and after an episode of GvHD recurrence and colic cytomegalovirus reactivation. Antiparasitic treatment was stopped and azithromycin and rifaximine were started. Immunosuppressive therapy was also reduced. The good clinical evolution allowed for the cessation of all medications. In conclusion, Cryptosporidium infection can complicate allo-SCT and be mistaken for GvHD at the clinical and histologic levels. Early and accurate diagnosis is all the more important as the therapeutic approach for the two conditions is opposite: reduction versus intensification of immunosuppressive therapy. Nitazoxanide, paromomycin, and azithromycin are the first therapeutic options.https://beta.karger.com/Article/FullText/531571cryptosporidiosisallogeneic stem-cell transplantationdiffuse large b-cell lymphoma |
| spellingShingle | Edwige Boulet Carlos Graux Anne Sonet Julien Depaus Hélène Vellemans Marc André Caroline Fervaille Elodie Collinge Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation Case Reports in Oncology cryptosporidiosis allogeneic stem-cell transplantation diffuse large b-cell lymphoma |
| title | Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation |
| title_full | Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation |
| title_fullStr | Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation |
| title_full_unstemmed | Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation |
| title_short | Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation |
| title_sort | cryptosporidiosis an uncommon complication after allogeneic stem cell transplantation |
| topic | cryptosporidiosis allogeneic stem-cell transplantation diffuse large b-cell lymphoma |
| url | https://beta.karger.com/Article/FullText/531571 |
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