Transplantation-associated thrombotic microangiopathy after steroid pulse therapy for polyserositis related to graft-versus-host disease.
Transplantation-associated thrombotic microangiopathy (TA-TMA) is a rare but devastating syndrome that occurs in allogeneic hematopoietic stem cell transplant recipients, and is associated with a variety of transplantation-related factors, including conditioning regimens, immunosuppressive agents, graft-versus-host disease (GVHD) and opportunistic infections. TA-TMA has an unfavorable prognosis and responds poorly to conventional treatment including plasma exchange (PE). We present a case of a 37-year-old man with membranous nephropathy (MN) and polyserositis caused by GVHD after hematopoietic stem cell transplantation. He developed TA-TMA after steroid pulse therapy for polyserositis. We treated the patient with PE and mycophenolate mofetil (MMF) after which the TA-TMA successfully improved and the MN underwent complete remission. The present case suggests that corticosteroids with severe GVHD might increase the risk of TA-TMA, and that PE in combination with MMF may be a valuable therapy to improve the prognosis.
Department of Medicine II, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, Hokkaido 060-8638, Japan.
Yasunobu
Y
Ishikawa
Saori
S
Nishio
Hiroaki
H
Sasaki
Risshi
R
Kudo
Hideki
H
Goto
Masanori
M
Ito
Akira
A
Suzuki
Yuichiro
Y
Fukazawa
Toshio
T
Mochizuki
Takao
T
Koike
D000328:Adult; D006086:Graft vs Host Disease / Q000150:complications* / Q000188:drug therapy* / Q000503:physiopathology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007668:Kidney / Q000473:pathology; D008297:Male; D020551:Pulse Therapy, Drug; D013256:Steroids / Q000008:administration & dosage* / Q000627:therapeutic use*; D057049:Thrombotic Microangiopathies / Q000209:etiology* / Q000473:pathology
D013256:Steroids