title: Pneumococcal arthritis affects performance status in patients with chronic GVHD of the skin following allogeneic bone marrow transplantation.
abstract: We encountered 2 patients with pneumococcal arthritis following bone marrow transplantation (BMT). Both patients received grafts from unrelated human lymphocyte antigen (HLA)-matched donors and had suffered from chronic graft-versus-host disease (GVHD). One, a 10-year-old boy, suffered from Epstein-Barr virus-related lymphoproliferative disease (EB-LPD) and received oral 6-mercaptopurine and methotrexate to manage lymphadenopathy. Twenty-four months after BMT and 7 months after the onset of EB-LPD, pneumococcal arthritis occurred in both knee joints. The other patient, a 10-year-old girl, received multiagent immunosuppressive therapy for her chronic GVHD. At 51 months following BMT, pneumococcal arthritis occurred in her left knee joint. Chronic GVHD of the skin delayed the recovery from the arthritis in both patients. This complication is quite rare but can be very serious, in regard to the patient's performance status following BMT. Although vaccination against pneumococcus or preventive antibiotics should be administered to high-risk patients, early diagnosis and treatment may be the best strategy for pneumococcal arthritis.
authors.affiliation: Department of Pediatrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Japan. nsakata@mch.pref.osaka.jp
authors.forename: N
authors.initials: N
authors.lastname: Sakata
authors.forename: M
authors.initials: M
authors.lastname: Yasui
authors.forename: K
authors.initials: K
authors.lastname: Kawa
mesh_terms: D000900:Anti-Bacterial Agents; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D003131:Combined Modality Therapy; D003428:Cross Infection / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D020031:Epstein-Barr Virus Infections / Q000209:etiology; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000473:pathology; D006801:Humans; D016867:Immunocompromised Host; D007719:Knee Joint; D015479:Leukemia, Myelomonocytic, Acute / Q000150:complications / Q000188:drug therapy / Q000628:therapy*; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000821:virology; D008297:Male; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology*; D014184:Transplantation, Homologous / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents