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Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation

Parasitic infections by Cryptosporidium species are rare but can be life-threatening disease after allogeneic stem-cell transplantation (allo-SCT). Here, we reported a case of cryptosporidiosis occurring after a reduced-intensity conditioning and allo-SCT in a 64-year-old farmer with diffuse large B...

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Autores principales: Boulet, Edwige, Graux, Carlos, Sonet, Anne, Depaus, Julien, Vellemans, Hélène, André, Marc, Fervaille, Caroline, Collinge, Elodie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: S. Karger AG 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601728/
https://www.ncbi.nlm.nih.gov/pubmed/37900815
http://dx.doi.org/10.1159/000531571
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author Boulet, Edwige
Graux, Carlos
Sonet, Anne
Depaus, Julien
Vellemans, Hélène
André, Marc
Fervaille, Caroline
Collinge, Elodie
author_facet Boulet, Edwige
Graux, Carlos
Sonet, Anne
Depaus, Julien
Vellemans, Hélène
André, Marc
Fervaille, Caroline
Collinge, Elodie
author_sort Boulet, Edwige
collection PubMed
description Parasitic infections by Cryptosporidium species are rare but can be life-threatening disease after allogeneic stem-cell transplantation (allo-SCT). Here, we reported a case of cryptosporidiosis occurring after a reduced-intensity conditioning and allo-SCT in a 64-year-old farmer with diffuse large B-cell lymphoma. Around day 70 after allo-SCT, he presented with diarrhea attributed to graft-versus-host disease (GvHD) and was treated with immunosuppressive therapy. Due to the patient’s worsening clinical condition, a biopsy review was performed, revealing evidence of cryptosporidiosis. Therefore, immunosuppressive therapy was progressively decreased, and antimicrobial therapy including paromomycin and azithromycin was initiated. Following an increase in diarrhea, a second-line treatment with nitazoxanide was administered, resulting in gradual improvement of symptoms. However, recurrence of cryptosporidiosis occurred despite treatment with paromomycin 6 months after transplant and after an episode of GvHD recurrence and colic cytomegalovirus reactivation. Antiparasitic treatment was stopped and azithromycin and rifaximine were started. Immunosuppressive therapy was also reduced. The good clinical evolution allowed for the cessation of all medications. In conclusion, Cryptosporidium infection can complicate allo-SCT and be mistaken for GvHD at the clinical and histologic levels. Early and accurate diagnosis is all the more important as the therapeutic approach for the two conditions is opposite: reduction versus intensification of immunosuppressive therapy. Nitazoxanide, paromomycin, and azithromycin are the first therapeutic options.
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spelling pubmed-106017282023-10-27 Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation Boulet, Edwige Graux, Carlos Sonet, Anne Depaus, Julien Vellemans, Hélène André, Marc Fervaille, Caroline Collinge, Elodie Case Rep Oncol Case Report Parasitic infections by Cryptosporidium species are rare but can be life-threatening disease after allogeneic stem-cell transplantation (allo-SCT). Here, we reported a case of cryptosporidiosis occurring after a reduced-intensity conditioning and allo-SCT in a 64-year-old farmer with diffuse large B-cell lymphoma. Around day 70 after allo-SCT, he presented with diarrhea attributed to graft-versus-host disease (GvHD) and was treated with immunosuppressive therapy. Due to the patient’s worsening clinical condition, a biopsy review was performed, revealing evidence of cryptosporidiosis. Therefore, immunosuppressive therapy was progressively decreased, and antimicrobial therapy including paromomycin and azithromycin was initiated. Following an increase in diarrhea, a second-line treatment with nitazoxanide was administered, resulting in gradual improvement of symptoms. However, recurrence of cryptosporidiosis occurred despite treatment with paromomycin 6 months after transplant and after an episode of GvHD recurrence and colic cytomegalovirus reactivation. Antiparasitic treatment was stopped and azithromycin and rifaximine were started. Immunosuppressive therapy was also reduced. The good clinical evolution allowed for the cessation of all medications. In conclusion, Cryptosporidium infection can complicate allo-SCT and be mistaken for GvHD at the clinical and histologic levels. Early and accurate diagnosis is all the more important as the therapeutic approach for the two conditions is opposite: reduction versus intensification of immunosuppressive therapy. Nitazoxanide, paromomycin, and azithromycin are the first therapeutic options. S. Karger AG 2023-08-09 /pmc/articles/PMC10601728/ /pubmed/37900815 http://dx.doi.org/10.1159/000531571 Text en © 2023 The Author(s). Published by S. Karger AG, Basel https://creativecommons.org/licenses/by-nc/4.0/This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.
spellingShingle Case Report
Boulet, Edwige
Graux, Carlos
Sonet, Anne
Depaus, Julien
Vellemans, Hélène
André, Marc
Fervaille, Caroline
Collinge, Elodie
Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation
title Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation
title_full Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation
title_fullStr Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation
title_full_unstemmed Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation
title_short Cryptosporidiosis, an Uncommon Complication after Allogeneic Stem-Cell Transplantation
title_sort cryptosporidiosis, an uncommon complication after allogeneic stem-cell transplantation
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601728/
https://www.ncbi.nlm.nih.gov/pubmed/37900815
http://dx.doi.org/10.1159/000531571
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