Sarcoidosis in donor-derived tissues after haematopoietic stem cell transplantation

Abstract

To the Editor: This is the first case of sarcoidosis in donor-derived tissues, confirmed by fluorescence in situ hybridisation (FISH), after haematopoietic stem cell transplantation (HSCT). A 64-year-old Japanese female was diagnosed to have adult T-cell leukaemia in December 2009. She had neither any past history nor a family history of sarcoidosis. She underwent HSCT (unrelated bone marrow transplantation) in May 2010, after receiving treatment with fludarabine, busulfan, and total body irradiation, from a human leukocyte antigen (HLA)-matched male donor who had no history of sarcoidosis. Although no lung involvement was seen in the early phase after HSCT, she was complicated by cytomegalovirus viraemia and acute graft versus host disease (GVHD), which required ganciclovir, systemic steroids and tacrolimus hydrate. She had achieved a negative proviral load of human T-cell lymphocytic virus (HTLV)-1 in her peripheral blood, 3 months after the transplant. At that time, the patient did not show any skin or eye symptoms or liver dysfunction, which are symptoms that are often seen in patients with chronic GVHD. A subcutaneous mass developed on her left upper arm in September 2011 (16 months after the transplant), although the proviral load of HTLV-1 remained negative. Fluorodeoxyglucose positron emission tomography (FDG-PET) or computed tomography (CT) imaging showed FDG accumulations in the mediastinal and hilar lymphadenopathy, in addition to the mass lesion located on the left upper arm. Although …