A 2-Year-Old Boy With Difficulty Waking After Bone Marrow Transplantation.

Area of Science:

• Pediatric Neurology
• Hematology
• Immunology

Background:

• Wiskott-Aldrich syndrome is a rare primary immunodeficiency requiring bone marrow transplantation.
• Bone marrow transplantation can lead to various immune-mediated complications.
• Prolonged intensive care unit stays can present diagnostic challenges for neurological complications.

Observation:

• A 2-year-old boy developed neurological symptoms including nuchal rigidity, decreased movement, and areflexia during intensive care.
• Electromyography revealed a length-dependent, axonal, sensorimotor polyneuropathy.
• Cerebrospinal fluid analysis showed albuminocytologic dissociation.

Findings:

• The patient's presentation was suggestive of Guillain-Barre syndrome or its variant, acute motor and sensory axonal neuropathy.
• The neurological deficit developed during intensive care admission following bone marrow transplant.
• The patient experienced slow motor recovery over several months with immunotherapy.

Implications:

• This case highlights a rare neurological complication post-bone marrow transplant for Wiskott-Aldrich syndrome.
• Early recognition and immunotherapy are crucial for managing such immune-mediated neurological disorders.
• Understanding these complications is vital for optimizing care in pediatric transplant recipients.