Autopsy-identified infections among bone marrow transplant recipients: a clinico-pathologic study of 56 patients. Bone Marrow Transplantation Team

We reviewed the autopsy records of 56 patients who had undergone BMT at the Detroit Medical Center during 1988-1992. Most patients (43 of 56) had died within 2 months of BMT. One or more infections were identified at autopsy in 25 of 40 (63%) allogeneic and four of 16 (25%) autologous BMT recipients. Microorganisms isolated at autopsy were cytomegalovirus (CMV) (14 patients), yeasts (13 patients), molds (aspergillus six patients, mucor one patient) and bacteria (seven patients). Presence of infection was not identified or proven prior to death in nine of 14 patients (65%) with CMV, six of 13 patients (46%) with yeasts and four of six patients (67%) with aspergillus. Most bacterial infections (five of seven patients) were identified ante-mortem. Lungs and the gastrointestinal tract were the organ systems mostly involved in patients with or without autopsy-identified infections. Pathologic findings in the lungs were diffuse alveolar damage, interstitial pneumonia and bronchopneumonia and, in the gastrointestinal tract, were ulcerations and hemorrhages of esophagus, stomach, small and large intestines. Examination of the heart showed non-bacterial thrombotic endocarditis (NBTE) in five patients, four with right-sided involvement only. Failure to identify non-bacterial pathogens ante-mortem and their frequent association with mortality in bone marrow transplant patients are high-lighted in the present study.