Chronic demyelinating polyneuropathy in graft-versus-host disease following allogeneic bone marrow transplantation.
In recent years a novel problem has arisen in organ transplantation medicine, namely GVHD. The nervous system has been involved mainly at the level of the CNS and this can lead to a serious outcome for the patient. In rare cases, peripheral nerves may be affected and show acute or chronic polyneuropathy. Here a case is reported of polyneuropathy associated with chronic GVHD. A 32-year-old man, suffering from chronic GVHD following an allogeneic bone marrow transplantation (BMT) for malignant lymphoma at the age of 25, developed a motor dominant polyneuropathy 5 years later. Electrophysiologic studies demonstrated the demyelinating type of polyneuropathy. Biopsy specimens from skin and skeletal muscle disclosed perivascular lymphocytic infiltrates expressing T-cell markers. The sural nerve showed a loss of myelinated nerve fibers with epineurial fibrosis and rare occurrence of T cells, but without obvious vasculitic changes. The present case suggested that polyneuropathy could develop in association with chronic GVHD in some patients with a long-standing disease course.
Nagashima
Toshiko
T
Department of Neurology, Teine Keijinkai Hospital, Japan.
Sato
Fumie
F
Chuma
Takayo
T
Mano
Yukio
Y
Sasaki
Isao
I
Mori
Masamitsu
M
Higa
Toshio
T
Masauji
Nobuo
N
Kasai
Masaharu
M
Orba
Yasuko
Y
Shinohara
Toshiya
T
Nagashima
Kazuo
K
D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002908:Chronic Disease; D003711:Demyelinating Diseases / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D006086:Graft vs Host Disease / Q000150:complications* / Q000276:immunology; D006801:Humans; D008223:Lymphoma / Q000628:therapy; D008297:Male; D011115:Polyneuropathies / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D013601:T-Lymphocytes / Q000276:immunology