Reconstitution Graves' disease following autologous haematopoietic stem cell transplantation for severe diffuse systemic sclerosis

Abstract

The term ‘reconstitution Graves’ disease’ has been used by Weetman1 to refer to the development of autoimmune thyroid disease following immune recovery from immunosuppressed states. The phenomenon has long been recognized in association with allogeneic haematopoietic stem cell transplantation (HSCT), where adoptive donor immunity and immune dysregulation related to graft-versus-host disease explains the occurrence of Graves’ disease. More recently, reconstitution Graves’ disease has been described in the context of autologous immune recovery following highly active antiretroviral therapy (HAART) in HIV and alemtuzumab treatment of multiple sclerosis, where the exact mechanism remains unclear. We wish to add a further context for autologous reconstitution Graves’ disease supported by a case of florid Graves’ thyroid and eye disease following high-dose cytotoxic chemotherapy with autologous HSCT for severe diffuse systemic sclerosis.2 A 36-year-old female was diagnosed with diffuse cutaneous systemic sclerosis (dsSSc) based on Raynaud’s phenomenon, scleroderma affecting her arms, neck, face and abdomen, fingertip ulceration and severe gastro-oesophageal reflux disease (GORD) in February 2005. Extractable nuclear antigen (ENA) screen was negative but anti-nuclear antibody (ANA) was weakly positive (speckled pattern). The course was rapidly progressive with development …