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KMID : 0366220050400020106
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Korean Journal of Hematology
2005 Volume.40 No. 2 p.106 ~ p.110
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A Case of Systemic Sclerosis Developed after Autologous Hematopoietic Stem Cell Transplantation in the Patient with Multiple Sclerosis
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Kim Woo-Sin
Min Chang-Ki
Yang Dong-Won
Park Yu-Kyung
Choi Son-Ook
Kim Jin-Soo
Lee Hyuck
Cho Chul-Soo
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Abstract
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This case report describes a 43-year-old woman with a relapsing-remitting variant of multiple sclerosis (MS), which began when she was 34 years of age and giving rise to severe neurological complications including progressive paralysis in both legs and visual deterioration. Despite the heavy immunomodulatory treatment, her condition relapsed and became aggravated. At this point a decision was made to perform an autologous hematopoietic stem cell transplantation (HSCT). The enrichment of CD34+ cells was followed by the depletion of peripheral T cells. The post-transplantation course was uneventful, and autoimmune thrombocytopenia developed within in 7 months after the HSCT. The patient was treated with cyclosporine (CsA) and oral prednisolone. However, she subsequently developed systemic sclerosis (SSc). The administration of CsA following the syngeneic/autologous HSCT caused a T lymphocyte- dependent autoimmune disease resembling graft-versus-host disease (GVHD). It is quite probable that the auto-reactive lymphocytes, which were paradoxically elicited by the CsA during the reconstitution of the immune system, partly contribute to occurrence of another autoimmune disease, SSc. To our knowledge, this is the first description of a MS patient who underwent CD34+-selected autologous HSCT followed by the administration of CsA who then developed SSc.
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KEYWORD
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Multiple sclerosis, Systemic sclerosis, Autologous GVHD, Hematopoietic stem cell transplantation, Cyclosporine
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