title: Granulocytic invasion of the central nervous system after hematopoietic stem cell transplantation for systemic lupus erythematosus.
abstract: We report on the likely mechanism of an exacerbation of neurological symptoms developed during immune reconstitution after autologous non-myeloablative hematopoietic stem cell transplantation in a 33-year-old man with systemic lupus erythematosus- associated recurrent transverse myelitis. Cerebrospinal fluid examination revealed prominent neutrophilic pleocytosis and no evidence of infection or of reactivation of lupus. Following a course of corticosteroid treatment the exacerbation resolved completely and the patient's neurological function continued to improve, resulting in net gain above pre-treatment for over 1 year follow-up without maintenance immunosuppression. Granulocytic invasion of the central nervous system represents a novel and possibly preventable cause of neurological complications during haematologic reconstitution.
authors.affiliation: National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Paolo A
authors.initials: PA
authors.lastname: Muraro
authors.forename: Nikolay P
authors.initials: NP
authors.lastname: Nikolov
authors.forename: John A
authors.initials: JA
authors.lastname: Butman
authors.forename: Andrea
authors.initials: A
authors.lastname: Abati
authors.forename: Juan
authors.initials: J
authors.lastname: Gea-Banacloche
authors.forename: Ronald
authors.initials: R
authors.lastname: Gress
authors.forename: Peter
authors.initials: P
authors.lastname: Lipsky
authors.forename: Gabor
authors.initials: G
authors.lastname: Illei
authors.forename: Steven
authors.initials: S
authors.lastname: Pavletic
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D002493:Central Nervous System Diseases / Q000097:blood* / Q000188:drug therapy; D006098:Granulocytes / Q000473:pathology*; D019650:Hematopoietic Stem Cell Mobilization; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007958:Leukocyte Count; D008180:Lupus Erythematosus, Systemic / Q000628:therapy*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D009504:Neutrophils
chemical_list: D000305:Adrenal Cortex Hormones; D008775:Methylprednisolone