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Case Reports
. 2022 Mar 15;17(5):1601-1604.
doi: 10.1016/j.radcr.2022.02.021. eCollection 2022 May.

Stem cell induced inflammatory hypertrophy of the cauda equina

Aaron D Brumbaugh  1 , Alan Podolsky  1 , Matthew H Kulzer  1 , Michael P Spearman  1 , Michael F Goldberg  1 , Warren M Chang  1 , Nazia Khatoon  2 , Kossivi Dantey  2 , Charles Q Li  1
Affiliations
Case Reports

Stem cell induced inflammatory hypertrophy of the cauda equina

Aaron D Brumbaugh et al. Radiol Case Rep. .

Abstract

Stem cell therapy can present clinicians with challenging clinical scenarios, as access to such treatments outpaces the research into their efficacy and safety due to the burgeoning trend of international travel to acquire stem cell therapy, or "stem cell tourism." Treatment of neurologic conditions remains an enticing potential application of stem cell therapy, often administered intrathecally. In response to such therapy, multiple adverse events have been described in the literature, including neoplasms, demyelinating disease, and seizures, among others. We present a case of symptomatic inflammatory cauda equina nerve root hypertrophy due to intrathecal stem cell infusion, representing a rare but significant complication.

Keywords: Adverse effects; Inflammatory nerve root hypertrophy; Intrathecal stem cell; Stem cell tourism.

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Figures

Fig 1 –
Fig. 1
T2-weighted MRI sequences from June 2017 (A, C) and November 2020 (B, D). Progressive diffuse thickening of the cauda equina nerve roots with near complete effacement of the CSF from L1-L5 over a 3 year period despite posterior decompression.
Fig 2 –
Fig. 2
Fat saturated T1-weighted contrast-enhanced MR images from June 2017 (A, C) and November 2020 (B, D). Mild but diffusely abnormal enhancement of the cauda equina nerve roots spanning the conus medullaris through the sacral canal.
Fig 3 –
Fig. 3
Histologic evaluation of nerve root biopsy. (A) Hematoxylin and eosin staining at x100 magnification; (B) Positive immunohistochemical staining for glial fibrillary acidic protein (GFAP), indicating the presence of mature glial cells; (C) Hematoxylin and eosin staining at x400 magnification demonstrating the presence of lymphocytes (black arrow); (D) CD3 immunohistochemical staining highlighting the presence of T-cell lymphocytes (black arrow) and ongoing chronic inflammation.
See this image and copyright information in PMC

References

    1. Hurst RW, Bosch EP, Morris JM, Dyck PJB, Reeves RK. Inflammatory hypertrophic cauda equina following intrathecal neural stem cell injection. Muscle Nerve. 2013;48(5):831–835. doi: 10.1002/mus.23920. - DOI - PubMed
    1. Aoun SG, Reyes VP, El Ahmadieh TY, Davies M, Patel AR, Ban VS, et al. Stem cell injections for axial back pain: a systematic review of associated risks and complications with a case illustration of diffuse hyperplastic gliosis resulting in cauda equina syndrome. J Neurosurg Spine. 2019;31:906–913. doi: 10.3171/2019.6.SPINE19594. - DOI - PubMed
    1. Kimbrel EA, Lanza R. Next-generation stem cells – ushering in a new era of cell-based therapies. Nat Rev Drug Discov. 2020;(7):463–479. doi: 10.1038/s41573-020-0064-x. - DOI - PubMed
    1. National Institutes of Health. ClinicalTrials.gov. Accessed 18 December 2021.
    1. Berkowitz AL, Miller MB, Mir SA, Cagney D, Chavakula V, Guleria I, et al. Glioproliferative lesion of the spinal cord as a complication of “stem cell tourism”. N Engl J Med. 2016;375:196–198. doi: 10.1056/NEJMc1600188. - DOI - PubMed

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