Successful treatment with HLA-matched peripheral hematopoietic stem cell transplantation for very severe hepatitis-associated aplastic anemia complicated with multidrug-resistant bacterial and fungal infections: A case report

Abstract

Hepatitis-associated aplastic anemia (HAAA) is a life-threatening hematologic disorder characterized by bone marrow failure. Allogeneic hematopoietic stem cell transplantation (HSCT) is the first-line treatment for HAAA. Severe infection and complications in patients with very severe aplastic anemia are the challenges to the efficacy of HSCT. We report a rare case of successful transplantation with HLA-matched peripheral hematopoietic stem cells for a 15-year-old girl suffering from HAAA with multidrug-resistant bacterial and fungal infections. Through effectively controlling infection and optimal timing of transplantation by adjusting the conditioning regimen, the allo-HSCT was successfully performed for the patient. Updated data of following-up 26 months after transplantation showed that the patient was still in complete remission with a good quality of life. This case provided a reference for treating severely infected patients with HAAA before HSCT.

Keywords: hematopoietic stem cell transplantation; hepatitis-associated aplastic anemia; multidrug-resistant bacteria; severe infection; very severe anemia plastic.

Figure 1

Change of oral fungal infections (A) on day −7 before HSCT, (B) on day +30 after HSCT, and (C) on day +55 after HSCT.

Figure 2

Dynamic images of pneumonia before and after transplantation (A–C). Chest high-resolution computed tomography: (A) 3.3 × 2.7 cm nodular shadow in the right upper lung, with bilateral pleural effusion on day −7 before HSCT, (B) 3.3 × 3.1 cm nodular shadow in the right upper lung, with bilateral pleural effusion and left atelectasis on day +22 after HSCT, and (C) 2.3 × 2.0 cm nodular shadow in the right upper lung on day +59 after HSCT.

Figure 3

Change in inflammatory factor levels in CRP (A), PCT (B), IL-6 (C), and GM (D). The red dot in the line represents the beginning of preconditioning on Dec. 25, 2019, and the yellow dot represents the day of HSCT on Jan. 1, 2020. The patient received HSCT when inflammatory factors levels reduced markedly.