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• Vol.62 No.1
• CLINICA NEUROL, 62: 33−38, 2022
• Vol.62 No.1 contents

Case Report

Central nervous system involvement of graft versus host disease after allogeneic hematopoietic stem cell transplantation for adult T cell leukemia

Toshihiro Ide, M.D.¹⁾, Kotaro Iida, M.D.¹⁾, Hiroo Katsuya, M.D., Ph.D.²⁾, Hiroshi Ito, M.D., Ph.D.³⁾, Shinichi Aishima, M.D., Ph.D.⁴⁾ and Hideo Hara, M.D., Ph.D.¹⁾

¹⁾ Division of Neurology, Department of Internal Medicine, Saga University, Faculty of Medicine
²⁾ Division of Hematology, Department of Internal Medicine, Saga University, Faculty of Medicine
³⁾ Department of Neurosurgery, Saga University, Faculty of Medicine
⁴⁾ Department of Pathology and Microbiology, Saga University Faculty of Medicine

A 54-year-old woman was diagnosed with acute adult T-cell leukemia (ATL) in November 2015 and underwent allogeneic hematopoietic stem cell transplantation in March 2016. Cognitive impairment appeared suddenly around May 2019, and MRI of the brain showed cerebral white matter lesions. Cerebrospinal fluid examination showed no significant findings other than elevated protein. Brain biopsy showed inflammatory cells, (mainly CD8-positive T lymphocytes), infiltrating the white matter. Based on the pathological findings and the history of chronic graft versus host disease (GVHD) in the lungs and intestines, we diagnosed central nervous system involvement of GVHD (CNS-GVHD). Immunotherapy with steroids and mycophenolate mofetil resulted in improvement of the cognitive dysfunction and inflammatory findings in the spinal fluid. This case is the first report of CNS-GVHD in ATL, suggesting the importance of diagnosis by brain biopsy and the efficacy of immunotherapy.
Full Text of this Article in Japanese PDF (4248K)

(CLINICA NEUROL, 62: 33−38, 2022)
key words: adult T cell leukemia, allogeneic hematopoietic stem cell transplantation, graft versus host disease, cognitive impairment

(Received: 7-Jul-21)