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Zhang MM, Wang J, Sun D, Wang JX, Zhang JH, Xu JW. Case Report: Autoimmune encephalitis and other neurological syndromes with rare neuronal surface antibody in children after hematopoietic stem cell transplantation. Front Immunol 2023; 14:1274420. [PMID: 37954605 PMCID: PMC10637573 DOI: 10.3389/fimmu.2023.1274420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Neuronal surface antibody syndromes (NSAS) encompass a growing set of autoimmune neurological disorders, with their predominant clinical presentation being autoimmune encephalitis (AE). The most extensively documented form within NSAS is anti-N-methyl-D-aspartate receptor (NMDAR) autoimmunity. In contrast, other NSAS, such as anti-metabotropic glutamate receptor-5 (mGluR5) autoimmunity, are less common and less comprehensively characterized, particularly in pediatric cases. Case description In this instance, we present the case of a 7-year-old girl who exhibited abnormal behaviors following hematopoietic stem cell transplantation (HSCT). She received a diagnosis of anti-mGluR5 AE, and her Electroencephalogram (EEG) displayed an increased number of generalized slow waves during wakefulness. Treatment involved intravenous administration of gamma globulin and methylprednisolone, followed by oral prednisone tablets. Levetiracetam was introduced as an antiepileptic therapy during the pulse steroid therapy. Notably, the abnormal behaviors exhibited significant improvement after treatment. Conclusions To the best of our knowledge, this is the first report of rare pediatric NSAS involving anti-mGluR5 AE following HSCT. Enhancing our understanding and characterization of this condition may facilitate its recognition and treatment in children. Serum antibody testing could enable early identification and treatment of anti-mGluR5 AE.
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Affiliation(s)
- Ming-min Zhang
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Wang
- Division of Neurology, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dan Sun
- Division of Neurology, Wuhan Children’s Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jing-xuan Wang
- Wisdom Lake Academy of Pharmacy, Xi’an Jiaotong-Liverpool University, Suzhou, China
| | - Jun-hong Zhang
- Department of Pediatrics, The Central Hospital of Jingmen, Jingmen, China
| | - Jia-wei Xu
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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[Epidermolysa bullosa acquisita and graft-versus-host disease]. Ann Dermatol Venereol 2014; 141:369-73. [PMID: 24835650 DOI: 10.1016/j.annder.2014.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 12/22/2013] [Accepted: 01/10/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Epidermolysis bullosa acquisita (EBA) is a rare acquired blistering disorder caused by production of auto-antibody directed against type-VII collagen. Autoimmune disorders can occur after allogenic bone marrow transplantation as manifestations associated with chronic graft-versus-host disease (GVHD). To date, there have been 10 cases reported in the literature concerning autoimmune blistering diseases following allogenic stem-cell transplants. Herein we describe a new case involving EBA. OBSERVATION A 46-year-old woman developed EBA 4 years after allogenic cord blood transplantation for non-Hodgkin T-cell lymphoma complicated by acute digestive and cutaneous GVHD. At physical examination, she had some cutaneous blisters on the abdomen, arms and face, as well as numerous erosions in the buccal cavity. Direct immunofluorescence microscopy revealed linear IgG and C3 deposits along the dermal-epidermal basement membrane zone. Indirect immunofluorescence showed weak IgG G4 anti-basement membrane zone antibodies, which reacted with the dermal side of 1M NaCl-split skin; the autoantibodies were directed against type-VII collagen. This second case of EBA was evocative of a GVHD blistering disease. After the therapeutic failure of dapsone and of combined mycophenolate-prednisone, treatment with rituximab proved effective. DISCUSSION EBA may form part of the autoimmune signs associated with chronic GVH. The destruction of basement membrane and of epidermal basal cells that occurs in GVH could give rise to autoimmune bullous disease. However, in our patient, in whom manifestation of chronic GVH was restricted to the lungs, it is difficult to rule out the fortuitous onset of EBA, which presented at a sizeable interval after acute GVH.
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Numata A, Morishita Y, Mori M, Saito O, Takemoto F, Ando Y, Muto S, Yumura W, Kusano E. De Novo Postallogeneic Hematopoietic Stem Cell Transplant Membranous Nephropathy. EXP CLIN TRANSPLANT 2012; 11:75-8. [DOI: 10.6002/ect.2012.0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Maillard-Lefebvre H, Morell-Dubois S, Lambert M, Charlanne H, Launay D, Hachulla E, Yakoub-Agh I, Hatron PY. Graft-versus-host disease-related polymyositis. Clin Rheumatol 2010; 29:431-33. [PMID: 20069327 DOI: 10.1007/s10067-009-1350-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 09/07/2009] [Accepted: 12/17/2009] [Indexed: 11/27/2022]
Abstract
Chronic graft-versus-host disease (GVHD) sometimes mimics autoimmune diseases. We report the case of a 39-year-old patient who presented atypical polymyositis without elevated creatinine phosphokinase, related to a chronic GVHD following interruption of immunosuppressive treatment. Treatment with cyclosporine and corticosteroids resulted in complete and sustained remission of the polymyositis. The symptoms of chronic GVHD-related polymyositis are indistinguishable from those of idiopathic polymyositis. The context of transplantation and a decrease or interruption of prophylaxis suggest the diagnosis of GVHD-related polymyositis, especially if other manifestations of GVHD are associated. A suitably adapted treatment (association of corticotherapy and cyclosporine) improves polymyositis, and in most cases, a normal clinical state is achieved even if the symptoms were severe.
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Affiliation(s)
- Helene Maillard-Lefebvre
- Department of Internal Medicine, Regional University Hospital-Claude Huriez Hospital, Lille, France.
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Silvana B, Antonella LM, Basilia P, Trombetta D, Saija A, Salpietro C. Rituximab for the treatment of post-bone marrow transplantation refractory hemolytic anemia in a child with Omenn's syndrome. Pediatr Transplant 2007; 11:552-6. [PMID: 17631027 DOI: 10.1111/j.1399-3046.2007.00678.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Omenn's syndrome is a rare severe combined immunodeficiency that kills affected subjects before the end of the first year of life unless patients are treated with bone marrow transplantation (BMT). Unfortunately, post-BMT patients may develop autoimmune diseases, such as autoimmune hemolytic anemia (AIHA), which sometimes fails to respond to standard therapies. Rituximab is a chimeric, human, immunoglobulin G1/k monoclonal antibody specific for the CD20 antigen expressed on the surface of B lymphocytes. Rituximab is currently only labeled for treatment of B-cell lymphoproliferative disorders, such as B-cell non-Hodgkin's lymphoma and follicular lymphoma; however, it is also employed in the treatment of a variety of disorders mediated by auto-antibodies, such as AIHA and transplant-related autoimmune disorders. Herein, we describe the case of a 23-month-old male child with Omenn's syndrome, who had undergone BMT and was successfully treated with rituximab (375 mg/m(2) intravenously, weekly for three times) for refractory post-BMT hemolytic anemia. Our findings evidence that rituximab should be considered for treatment of post-BMT AIHA refractory to traditional therapy also in children with primary immunodeficiencies; furthermore, rituximab might represent a means to obtain remissions without the toxic effects associated with corticosteroid and immunosuppressive agents.
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Affiliation(s)
- Briuglia Silvana
- Paediatric Therapy, Operative Unit of Genetic and Immunology Paediatrics, University of Messina, Contrada Annunziata, 98168 Messina, Italy
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Moalic V, Ferec C. La réaction du greffon contre l'hôte. ACTA ACUST UNITED AC 2006; 54:304-8. [PMID: 16530350 DOI: 10.1016/j.patbio.2006.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2004] [Accepted: 01/27/2006] [Indexed: 10/24/2022]
Abstract
Graft vs host disease is a serious immunological complication of allogeneic haematopoietic cell transplantation, leading to a significant morbidity and mortality. It occurs when donor T lymphocyte react to foreign host cells. The physiopathology is a more complex process implicating host tissues damage caused by the conditioning regimen, cytokines, cellular effectors implicated in the immune response such as donor lymphocytes T, antigen presenting cells and mechanisms of apoptosis. This review focuses on the physiopathological basis, risk factors, clinical aspects; prevention and current management strategies to treat graft vs host disease. Recent developments in our understanding of this bone marrow transplantation complication have profoundly influenced the practice of allogeneic haematopoietic cell transplantation. There is a growing realisation of the importance of a graft vs leukaemia effect, strategy, which has encouraged the development of less conditioning regimens. Segregation between graft vs host effect and graft vs leukaemia effect is a key challenge, and could lead to new efficient and specific immunotherapy.
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Affiliation(s)
- V Moalic
- Laboratoire de génétique moléculaire et d'histocompatibilité, centre hospitalier universitaire Augustin-Morvan, 2, avenue Foch, 29200 Brest, France.
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Fricain JC, Sibaud V, Hafian H, Deminière C, Taiëb A, Boiron JM. Les manifestations buccales de la réaction du greffon contre l’hôte. Ann Dermatol Venereol 2005; 132:1017-25. [PMID: 16446654 DOI: 10.1016/s0151-9638(05)79574-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J-C Fricain
- Pôle d'Odontologie et Santé Buccale, CHU, Hôpital Pellegrin, place Amélie Raba Léon, 33000 Bordeaux.
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Kim WS, Min CK, Yang DW, Park YK, Choi SO, Kim JS, Lee H, Cho CS. A Case of Systemic Sclerosis Developed after Autologous Hematopoietic Stem Cell Transplantation in the Patient with Multiple Sclerosis. THE KOREAN JOURNAL OF HEMATOLOGY 2005. [DOI: 10.5045/kjh.2005.40.2.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Woo Sin Kim
- Department of Internal Medicine, Daerim Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang-Ki Min
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dong Won Yang
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yu Kyung Park
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Son Ook Choi
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin Soo Kim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeug Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul-Soo Cho
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Division of Rheumatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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