Engraftment Syndrome After Second Autologous Stem Cell Transplantation for Myeloma: A Case Report

Engraftment syndrome (ES) is a rare but challenging posttransplant complication, presenting during or after absolute neutrophil recovery. It may easily be confused with febrile infectious complications since its main clinical features include fever, extensive skin rash, diarrhea, and atypical pulmonary infiltrates. Its pathophysiology and potential trigger factors remain not well understood. An immunosuppressive therapy with corticosteroids represents the standard treatment, and most cases present a rapid resolution of symptoms after treatment initiation. Still, in cases of severe presentation including periengraftment respiratory distress syndrome (PERDS), a mortality rate up to 21% has been described. In this case report, we report the case of a male patient after second autologous stem cell transplantation (SCT) with recurrent febrile episodes with no response to usual antibiotic regimens. Our patient developed diarrhea from Day 9 post-SC, escalating to a full-body rash and atypical pneumonia on and after Day 16. Our diagnosis was based on the Maiolino criteria, and a corticosteroid treatment was instituted. The symptoms ceased 2 days later, while we continued the treatment for a week. Physicians should be aware of this rare clinical entity, which can mimic other common posttransplant complications, hindering prompt diagnosis and treatment.