内容紹介
Acute Transverse Myelitis after Allogeneic Bone Marrow Transplantation for Acute Lymphoblastic Leukemia―A Case Report
Summary
Transverse myelitis is an inflammatory disorder of the spinal cord that results in motor, sensory, and autonomic dysfunction. Herein, we describe a 40-year-old Japanese female who developed acute transverse myelitis(ATM)after an unrelated bone marrow transplantation for Philadelphia-positive acute lymphoblastic leukemia in molecular complete remission. Approximately 90 days after transplantation, she suffered from paresthesias, sphincter dysfunction, and lower extremity weakness. Spinal cord magnetic resonance imaging scan demonstrated findings consistent with ATM. The symptoms were resolved with the administration of steroids, followed by intravenous immunoglobulin therapy for a few sequelae. To the best of our knowledge, the presentation of ATM after hematopoietic stem cell transplantation is relatively rare. As the functional prognosis of ATM depends on prompt diagnosis and treatment, we consider that ATM should be included in the differential diagnosis of post-transplant myelopathies.
要旨
症例は40歳,女性。分子学的寛解を得たPhiladelphia染色体陽性急性リンパ性白血病に対して,非血縁者間骨髄移植を実施した。day 90ごろより知覚異常,膀胱直腸障害および下肢筋力低下を認め,MRI所見も含めて急性横断性脊髄炎と診断した。ステロイドパルスおよび免疫グロブリン製剤投与を行い,症状の改善を得た。横断性脊髄炎は運動,知覚および自律神経系に異常を来す炎症性疾患であるが,造血幹細胞移植での合併例は比較的まれである。早期の診断および治療開始が機能的予後に影響するため,移植後の脊髄症には急性横断性脊髄炎を鑑別診断として念頭に置く必要性がある。
目次
Summary
Transverse myelitis is an inflammatory disorder of the spinal cord that results in motor, sensory, and autonomic dysfunction. Herein, we describe a 40-year-old Japanese female who developed acute transverse myelitis(ATM)after an unrelated bone marrow transplantation for Philadelphia-positive acute lymphoblastic leukemia in molecular complete remission. Approximately 90 days after transplantation, she suffered from paresthesias, sphincter dysfunction, and lower extremity weakness. Spinal cord magnetic resonance imaging scan demonstrated findings consistent with ATM. The symptoms were resolved with the administration of steroids, followed by intravenous immunoglobulin therapy for a few sequelae. To the best of our knowledge, the presentation of ATM after hematopoietic stem cell transplantation is relatively rare. As the functional prognosis of ATM depends on prompt diagnosis and treatment, we consider that ATM should be included in the differential diagnosis of post-transplant myelopathies.
要旨
症例は40歳,女性。分子学的寛解を得たPhiladelphia染色体陽性急性リンパ性白血病に対して,非血縁者間骨髄移植を実施した。day 90ごろより知覚異常,膀胱直腸障害および下肢筋力低下を認め,MRI所見も含めて急性横断性脊髄炎と診断した。ステロイドパルスおよび免疫グロブリン製剤投与を行い,症状の改善を得た。横断性脊髄炎は運動,知覚および自律神経系に異常を来す炎症性疾患であるが,造血幹細胞移植での合併例は比較的まれである。早期の診断および治療開始が機能的予後に影響するため,移植後の脊髄症には急性横断性脊髄炎を鑑別診断として念頭に置く必要性がある。