Abstract
Gastrointestinal graft-versus-host disease (GVHD) and cytomegalovirus (CMV) disease are common complications occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT), and contribute to a high degree of morbidity and mortality associated with allo-HSCT. Herein, we present a patient with severe intestinal GVHD complicated by recurring CMV enteritis, which overall resulted in severe terminal ileum stenosis. The patient underwent laparoscopic ileocecal resection that significantly reduced symptoms and possibly prevented the development of fulminant ileus. Surgical treatment is rarely used in the treatment of gastrointestinal GVHD; however, the current patient history illustrates that patients with inadequate symptom control and severe inflammatory bowel stenosis can be successfully managed with surgery. We also review published case reports on surgical treatment for severe gastrointestinal GVHD.
Highlights
Graft-versus-host disease (GVHD) is a severe complication seen after allogeneic hematopoietic stem cell transplantation [1,2]
GVHD has been treated with immunosuppressive agents such as cyclosporine, corticosteroids, tacrolimus, or mycophenolate mofetil [3]
After three cycles of 5-azacitidine, the patient achieved reduction in blast count to
Summary
Graft-versus-host disease (GVHD) is a severe complication seen after allogeneic hematopoietic stem cell transplantation (allo-HSCT) [1,2]. Immunosuppressive therapy in GVHD increases the risk of infectious complications [6], especially cytomegalovirus (CMV) reactivation or primary CMV disease [7]. With regular monitoring for CMV and pre-emptive treatment, severe CMV disease are seldom observed [7]. Recurrent CMV disease in the GI-tract, such as CMV enteritis, can be severe and may require long-term antiviral treatment that is often associated with side effects requiring prolonged hospitalization [7]. We present a patient with severe and obstructive bowel pathology after allo-HSCT, where surgical intervention was considered the only option for treatment of the patient’s symptoms and a review of the literature regarding surgical treatment of GI-tract complications after allo-HSCT
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