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Indolent aspergillus arthritis complicating fludarabine-based non-myeloablative stem cell transplantation
1Department of Bone Marrow Transplantation, Hadassah University Hospital, Hebrew University - Hadassah Medical School, Jerusalem, Israel.
Abstract:
Fungal arthritis and osteomyelitis are rare and documented mainly in immunocompromised or neutropenic patients. Patients receiving therapeutic immunosuppression for organ transplants have also reported to suffer from aspergillus osteoarthritis. We describe two patients with aspergillus arthritis of the knee joint following fludarabine-based non-myeloablative stem cell transplantation. Both were suffering from acute and chronic GVHD and treated with heavy immunosuppression including steroids and cyclosporine. Interestingly in one of our patients, the arthritis was almost asymptomatic and did not spread to other organs. Heavy pre- and post-transplant immunosuppression is a major risk factor for invasive fungal infection, which can involve remote organs and manifest in an indolent and atypical manner.
Insights
Fungal arthritis is rare in stem cell transplant patients. Heavy immunosuppression increases risk for invasive fungal infections, which can present atypically.
Area of Science:
- Infectious Diseases
- Hematology
- Immunology
Background:
- Fungal arthritis and osteomyelitis are uncommon, primarily affecting immunocompromised individuals.
- Aspergillus osteoarthritis has been reported in organ transplant recipients on immunosuppressive therapy.
Observation:
- This study describes two cases of Aspergillus arthritis in the knee following fludarabine-based non-myeloablative stem cell transplantation.
- Both patients had acute and chronic graft-versus-host disease (GVHD) and received intensive immunosuppression (steroids, cyclosporine).
Findings:
- One patient presented with nearly asymptomatic arthritis, without systemic spread.
- Invasive fungal infections post-transplant can manifest indolently and atypically.
Implications:
- Heavy immunosuppression is a significant risk factor for invasive fungal infections after stem cell transplantation.
- Clinicians should consider fungal infections in transplant recipients, even with subtle or atypical presentations.