Inflammatory Bowel Disease Following Allogeneic Hematopoietic Cell Transplant for Sickle Cell Disease

Although graft-versus-host disease (GvHD) is an important cause of gastrointestinal (GI) complications after allogeneic hematopoietic stem cell transplantation (HCT), the non-specific symptoms make diagnosis challenging. We described three patients with sickle cell disease who developed inflammatory bowel disease (IBD) like manifestations 4-18 months post-HCT. All patients received peripheral blood stem cell grafts and sirolimus for GvHD prophylaxis. All had chronic diarrhea, and biopsies showed extensive colonic ulceration, non-necrotizing granulomas, with minimal histologic evidence of GvHD. Symptoms resolved promptly with IBD-directed therapy. Our report highlights the importance of considering alternative rare etiologies for GI complications such as IBD after HCT.